The ISCHEMIA trial (2019) enrolled stable CAD patients with moderate-to-severe ischaemia on stress testing. Its KEY finding compared to earlier assumptions was:
- A Routine invasive strategy (PCI/CABG) significantly reduced myocardial infarction compared to optimal medical therapy
- B CABG was superior to PCI for all anatomical subgroups
- C Routine invasive strategy did NOT reduce the composite of death or MI versus optimal medical therapy over 3.2 years ✓
- D Stress testing is unreliable for guiding revascularisation decisions
Correct answer: C. Routine invasive strategy did NOT reduce the composite of death or MI versus optimal medical therapy over 3.2 years
Explanation
The ISCHEMIA trial (5179 patients, median follow-up 3.2 years) showed no significant difference in the primary composite outcome (CV death, MI, resuscitated cardiac arrest, hospitalisation for unstable angina or heart failure) between an initial invasive strategy and conservative medical management in patients with stable CAD and moderate-to-severe ischaemia. This challenged the assumption that revascularisation reduces hard events in stable CAD, reinforcing that optimal medical therapy is the foundation of treatment for stable ischaemic heart disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.