The ISCHEMIA trial (2019) randomised stable patients with moderate-severe ischaemia on stress testing to initial invasive strategy vs. optimal medical therapy. What was its primary finding relevant to clinical decision-making?
- A Routine invasive strategy significantly reduced myocardial infarction and death compared to OMT
- B Initial invasive strategy did not reduce the primary composite of death, MI, hospitalisation for unstable angina, heart failure, or resuscitated cardiac arrest compared to OMT in stable CAD ✓
- C PCI was superior to CABG for all anatomical patterns of disease
- D OMT was inferior for symptom relief compared to PCI at 4 years
Correct answer: B. Initial invasive strategy did not reduce the primary composite of death, MI, hospitalisation for unstable angina, heart failure, or resuscitated cardiac arrest compared to OMT in stable CAD
Explanation
The landmark ISCHEMIA trial showed no significant difference in the primary composite endpoint between initial invasive and conservative (OMT) strategies in stable coronary artery disease patients with moderate-to-severe ischaemia. PCI/CABG did improve angina symptoms and quality of life. This reinforced that revascularisation should primarily be driven by symptoms rather than ischaemia burden alone in stable disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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