A 55-year-old man has stable angina with significant LAD stenosis on coronary angiogram. He is on optimal medical therapy (beta-blocker, statin, aspirin, nitrates). The ISCHEMIA trial's principal finding relevant to deciding between PCI and continued medical therapy in stable CAD is:
- A PCI reduced MACE (death, MI, stroke) significantly compared to medical therapy
- B PCI was superior in patients with moderate ischemia but not severe ischemia
- C An initial invasive strategy did not reduce the primary composite endpoint versus optimal medical therapy in stable ischemic heart disease ✓
- D Medical therapy was associated with higher rates of spontaneous MI
Correct answer: C. An initial invasive strategy did not reduce the primary composite endpoint versus optimal medical therapy in stable ischemic heart disease
Explanation
The ISCHEMIA trial (2019) enrolled stable CAD patients with at least moderate ischemia on stress testing and found no significant difference in the primary composite endpoint (cardiovascular death, MI, hospitalization for unstable angina, heart failure or resuscitated cardiac arrest) between an invasive strategy (PCI/CABG) and optimal medical therapy alone over a median 3.2 years. PCI did improve angina symptoms and quality of life. This trial does not apply to patients with left main disease or reduced ejection fraction.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.