The ISCHEMIA trial (2019) showed that, compared to conservative medical therapy alone in stable coronary artery disease with moderate-to-severe ischaemia, routine revascularisation (PCI or CABG):

• A Significantly reduced cardiovascular death and MI at 3.2 years
• B Reduced overall mortality but not non-fatal MI
• C Reduced urgent revascularisation but significantly increased procedural MI
• D Did not reduce the primary composite endpoint of CV death, MI, or hospitalisation ✓

Explanation

The ISCHEMIA trial (NEJM 2020) enrolled 5179 patients with stable CAD and moderate-to-severe ischaemia on stress testing. Routine invasive strategy (PCI/CABG) did not reduce the primary endpoint (CV death, MI, hospitalisation for unstable angina/HF/resuscitated cardiac arrest) compared to optimal medical therapy at median 3.2 years. The invasive group had higher early procedural MIs but fewer spontaneous MIs over time. These findings reinforced that ischaemia-guided revascularisation does not improve survival in stable CAD.

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

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Written and medically reviewed by the StethoPrep medical team.