The ISCHEMIA trial (2019) demonstrated that in stable coronary artery disease with moderate-to-severe ischemia, compared to conservative (optimal medical therapy alone), the routine invasive strategy (PCI/CABG):
- A Significantly reduced cardiovascular death and spontaneous MI at 3.3 years
- B Improved quality of life in angina patients but did not reduce MI or death significantly ✓
- C Reduced only procedural MI (periprocedural) without reducing spontaneous MI
- D Was superior in all outcomes including mortality in diabetics
Correct answer: B. Improved quality of life in angina patients but did not reduce MI or death significantly
Explanation
The ISCHEMIA trial (NEJM 2020) randomized 5179 patients with stable CAD and moderate-to-severe ischemia to invasive vs. conservative strategy. The primary composite endpoint (CV death, MI, hospitalization for unstable angina/HF, resuscitated cardiac arrest) did not differ significantly. However, the invasive strategy was associated with improved angina-related quality of life, particularly in those with frequent angina. There was no significant reduction in death or spontaneous MI; in fact, periprocedural MI rates were higher in the invasive group initially.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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