In the ISCHEMIA trial, which key finding changed the management paradigm for stable ischemic heart disease with moderate-to-severe ischaemia on non-invasive testing?
- A FFR-guided PCI significantly reduced mortality compared to medical therapy alone
- B Routine invasive strategy with PCI/CABG did not reduce death or MI compared to optimal medical therapy ✓
- C CABG was superior to PCI for all degrees of ischaemia regardless of anatomy
- D Early invasive strategy reduced hospitalisation for unstable angina significantly
Explanation
The ISCHEMIA trial (NEJM 2020), enrolling > 5,000 patients with stable coronary artery disease and moderate-to-severe ischaemia, demonstrated that a routine invasive strategy (coronary angiography followed by revascularisation when feasible) did not significantly reduce the primary outcome of cardiovascular death, MI, hospitalisation for unstable angina, heart failure, or resuscitated cardiac arrest compared with an initial conservative strategy of optimal medical therapy alone. This paradigm-shifting finding confirmed that medical therapy is the appropriate first step for stable CAD without acute coronary syndrome, with revascularisation reserved for refractory symptoms.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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