The ISCHEMIA trial (2019–2020) randomised stable ischaemic heart disease patients to initial invasive strategy versus optimal medical therapy. The trial's primary finding was:

• A Invasive strategy significantly reduced cardiovascular death and MI at 3.2 years
• B No significant difference in cardiovascular death or MI between strategies ✓
• C Invasive strategy significantly reduced all-cause mortality
• D Optimal medical therapy was associated with higher rates of unstable angina hospitalisation

Explanation

The ISCHEMIA trial (NEJM 2020) found no significant difference in the primary composite of cardiovascular death, non-fatal MI, hospitalised UA, heart failure or resuscitated cardiac arrest between an initial invasive strategy and optimal medical therapy alone in stable CAD over ~3.2 years. Early procedural MIs were higher in the invasive arm; late spontaneous MIs were lower. This challenged routine revascularisation for stable disease.

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

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Written and medically reviewed by the StethoPrep medical team.