The ISCHEMIA trial (2019) enrolled stable ischaemic heart disease patients with moderate-to-severe ischaemia on stress testing. What was its key finding regarding routine invasive strategy versus conservative management?
- A Routine revascularisation did not reduce the composite of death or myocardial infarction over median 3.3 years follow-up ✓
- B Routine revascularisation significantly reduced all-cause mortality
- C Routine revascularisation was superior in patients with eGFR > 45 but not lower
- D Routine revascularisation reduced death or MI only in patients with three-vessel disease
Explanation
The ISCHEMIA trial randomised 5,179 patients with stable ischaemic heart disease and moderate-to-severe ischaemia to routine invasive strategy (catheterisation ± revascularisation) versus initial conservative management. Over a median 3.3 years, there was no significant difference in the primary composite endpoint of cardiovascular death, MI, hospitalisation for unstable angina, HF, or resuscitated cardiac arrest. Revascularisation did provide superior angina relief. This trial importantly does not apply to patients with unprotected left main disease (excluded on CTA) or significant LV dysfunction.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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