The ISCHEMIA trial (2019) compared initial conservative management versus invasive coronary revascularisation in stable ischaemic heart disease with moderate-severe ischaemia. Which statement BEST reflects the key finding?
- A No significant difference in the primary outcome of cardiovascular death or MI between the two strategies over 3.2 years ✓
- B Invasive strategy significantly reduced the primary composite endpoint of cardiovascular death and myocardial infarction
- C Conservative strategy was associated with higher all-cause mortality
- D Invasive strategy eliminated angina completely in >90% of patients
Correct answer: A. No significant difference in the primary outcome of cardiovascular death or MI between the two strategies over 3.2 years
Explanation
The ISCHEMIA trial randomised over 5000 stable CAD patients with moderate-severe ischaemia and found no significant difference in the primary composite outcome (CV death, MI, hospitalisation for unstable angina/heart failure, or resuscitated cardiac arrest) between initial invasive and conservative strategies at a median follow-up of 3.2 years. Invasive therapy did offer better angina relief and quality of life but did not confer a mortality benefit. This profoundly changed the management paradigm for stable ischaemic heart disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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