The ISCHEMIA trial (2020) demonstrated which major finding regarding the management of stable ischaemic heart disease with moderate-to-severe ischaemia?
- A PCI was superior to CABG for all patient subgroups
- B Early revascularisation reduced 5-year mortality by 30%
- C Routine invasive strategy (PCI/CABG) did not reduce the rate of death or myocardial infarction compared to optimal medical therapy alone ✓
- D Optimal medical therapy was inferior to revascularisation for symptom control
Explanation
The ISCHEMIA trial enrolled over 5,000 patients with stable coronary disease and moderate-to-severe ischaemia on stress testing and showed no significant difference in the primary composite endpoint (cardiovascular death, MI, hospitalisation for unstable angina, heart failure, or resuscitated cardiac arrest) between an initial invasive strategy and an initial conservative strategy of optimal medical therapy. This trial shifted guidelines toward prioritising medical therapy for stable disease. Revascularisation did improve angina symptoms but not hard outcomes in this population.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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