In the ISCHEMIA trial, which patients with stable coronary artery disease and moderate-to-severe ischaemia showed a significant benefit from invasive revascularisation strategy over optimal medical therapy alone?
- A Patients with refractory angina despite optimal medical therapy ✓
- B All patients with EF >45% and significant ischaemia on stress testing
- C Patients with left main disease excluded from the trial
- D All patients regardless of symptom burden
Correct answer: A. Patients with refractory angina despite optimal medical therapy
Explanation
The ISCHEMIA trial (NEJM 2020) found NO significant difference in the primary outcome (CV death, MI, hospitalisation) between an invasive strategy and optimal medical therapy (OMT) over 3.3 years in stable CAD with moderate-to-severe ischaemia. However, patients with refractory or frequent angina had significant quality-of-life benefit with revascularisation. Left main disease was an exclusion criterion in ISCHEMIA. This landmark trial shifted the paradigm away from routine revascularisation for stable ischaemia without symptoms.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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