In chronic stable ischaemic heart disease, the ISCHEMIA trial (2019) compared complete revascularisation plus OMT versus OMT alone. The MAIN finding of the trial was:

• A Revascularisation significantly reduced all-cause mortality at 5 years
• B OMT alone was superior to revascularisation at reducing angina burden
• C Revascularisation significantly reduced stroke at 5 years
• D Revascularisation reduced spontaneous MI but there was no difference in death or primary MACE at median 3.2 years ✓

Explanation

The ISCHEMIA trial found no significant difference in the primary composite of CV death, MI, hospitalisation for unstable angina, HF, or resuscitated cardiac arrest between the invasive and conservative strategies at median 3.2 years. Spontaneous MI rates were lower with invasive strategy, but procedure-related MI was higher, resulting in no net difference. Revascularisation did improve angina symptom control. This trial reinforced that OMT is appropriate first-line in stable IHD without left main disease or severe LV dysfunction, with revascularisation reserved for symptom refractory disease.

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

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Written and medically reviewed by the StethoPrep medical team.