The ISCHEMIA trial (2019) studied patients with stable coronary artery disease and moderate-to-severe ischaemia on stress testing. Compared with medical therapy alone, routine invasive strategy with revascularisation showed which outcome?

• A Significant reduction in death from any cause
• B Significant reduction in non-fatal MI over follow-up
• C Significant improvement in survival in all pre-specified subgroups
• D No significant reduction in major adverse cardiovascular events at 3.2 years ✓

Explanation

The ISCHEMIA trial enrolled 5,179 patients with stable CAD and moderate-severe ischemia and found no significant difference in the primary composite endpoint (cardiovascular death, MI, hospitalisation for unstable angina or heart failure, or resuscitated cardiac arrest) at a median follow-up of 3.2 years between an invasive strategy and conservative medical therapy. This landmark trial reinforced optimal medical therapy as the initial approach for stable CAD.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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