A 55-year-old man with stable angina has undergone coronary angiography showing 70% stenosis in the left anterior descending artery. His symptoms are controlled on medical therapy. The ISCHEMIA trial demonstrated that in this setting, routine invasive revascularization versus optimal medical therapy resulted in:
- A Significant reduction in all-cause mortality at 3.2 years
- B No significant difference in major adverse cardiovascular events (MACE) at 3.2 years ✓
- C Significant reduction in MI rate but not mortality
- D Significant reduction in stroke but not MI
Correct answer: B. No significant difference in major adverse cardiovascular events (MACE) at 3.2 years
Explanation
The ISCHEMIA trial (2019) compared routine invasive management versus optimal medical therapy in 5179 patients with stable ischemic heart disease and moderate-to-severe ischemia. At median 3.2-year follow-up, there was no significant difference in the primary composite outcome of cardiovascular death, MI, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. Invasive management improved quality of life and angina symptoms but did not reduce MACE.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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