In the ISCHEMIA trial, which finding was demonstrated regarding stable ischaemic heart disease with moderate-to-severe ischaemia on stress testing?
- A Routine invasive strategy significantly reduced all-cause mortality
- B Routine invasive strategy did not reduce death or MI compared with optimal medical therapy ✓
- C PCI reduced hospitalisation for heart failure compared with medical therapy
- D Routine angiography improved quality of life in all patients
Correct answer: B. Routine invasive strategy did not reduce death or MI compared with optimal medical therapy
Explanation
The ISCHEMIA trial (2019) enrolled patients with stable coronary artery disease and at least moderate ischaemia on stress testing. After median 3.3-year follow-up, a routine invasive strategy did not reduce the composite of cardiovascular death, MI, hospitalisation for unstable angina, or cardiac arrest compared with optimal medical therapy. This fundamentally changed practice for stable IHD. Quality-of-life benefit from invasive strategy was limited to patients with more frequent angina.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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