In the ISCHEMIA trial, which finding was demonstrated regarding revascularization versus optimal medical therapy in stable ischemic heart disease with moderate-to-severe ischemia on stress testing?
- A Revascularization significantly reduced death or MI over 3 years
- B Medical therapy was superior due to periprocedural MI risk outweighing long-term benefit
- C Revascularization improved angina symptoms but did not reduce death or MI over median follow-up ✓
- D Revascularization reduced mortality only in patients with EF <35%
Explanation
The ISCHEMIA trial (2019) enrolled patients with stable CAD and moderate-to-severe ischemia and found no significant difference in the primary composite endpoint of cardiovascular death, MI, hospitalization for unstable angina/heart failure, or resuscitated cardiac arrest between initial invasive (PCI/CABG) and conservative (optimal medical therapy) strategies over a median 3.2 years. Revascularization did improve angina symptoms and quality of life, particularly in patients with more frequent angina. Patients with unprotected left main disease or very low EF were excluded.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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