According to the ISCHEMIA trial, which of the following is the correct conclusion regarding stable ischemic heart disease with moderate-severe ischemia on non-invasive testing?
- A Routine invasive strategy did not reduce the primary endpoint of cardiovascular death or MI compared to optimal medical therapy ✓
- B Routine PCI reduced cardiovascular mortality significantly over 4 years
- C Early revascularisation prevented progression to heart failure
- D Medical therapy alone increased risk of sudden cardiac death
Correct answer: A. Routine invasive strategy did not reduce the primary endpoint of cardiovascular death or MI compared to optimal medical therapy
Explanation
The ISCHEMIA trial (2019) enrolled ~5,000 stable CAD patients with moderate-severe ischemia and showed that routine early invasive strategy did not reduce the primary composite endpoint of cardiovascular death, MI, hospitalisation for unstable angina, heart failure, or resuscitated cardiac arrest compared to initial optimal medical therapy. This landmark trial fundamentally changed the approach to stable angina management. Revascularisation did provide symptom relief but no mortality benefit in stable disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.