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Review
. 2022 Jun;24(6):653-657.
doi: 10.1007/s11886-022-01684-7. Epub 2022 Mar 30.

Does the ISCHEMIA Trial Apply to My Patients?

Vandan Upadhyaya  1 , Smitha Narayana Gowda  2 , Gustavo Porto  3 , Chirag P Bavishi  4 , Partha Sardar  5 , Riyaz Bashir  6 , Mustafa Emir Gokceer  7 , Saurav Chatterjee  8
Affiliations
Review

Does the ISCHEMIA Trial Apply to My Patients?

Vandan Upadhyaya et al. Curr Cardiol Rep. 2022 Jun.

Abstract

Purpose of review: The ISCHEMIA trial demonstrated no difference in myocardial infarction or death in patients with stable coronary disease and moderate or large ischemia territory treated either with invasive revascularization or optimal medical therapy. Whether the findings of the randomized control trial relates to real-world outcomes is uncertain.

Recent findings: Contemporary guideline-directed medical therapy has had a significant impact on the prognosis of coronary artery disease. Various observational data appear to indicate limited generalizability of the ISCHEMIA trial in different populations. Further studies are warranted to evaluate the optimal modality of therapy in patients with stable coronary disease and moderate or severe ischemia. The applicability of ISCHEMIA and ISCHEMIA-CKD trials still requires further validation.

Keywords: Antianginal; Chest pain; Coronary disease; Ischemic heart disease; Revascularization.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of Major Importance
    1. •• Maron DJ, Hochman JS, Reynolds HR, et al. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med. 2020;382(15):1395–407. https://doi.org/10.1056/NEJMoa1915922 . Findings of this study revealed that death from cardiovascular causes, including myocardial infarctions, hospitalizations related to cardiovascular events, or cardiac arrest were not reduced with initial invasive strategy in patients with stable ischemic heart disease and moderate or severe ischemia when compared to initial conservative medical management strategy. - DOI - PubMed - PMC
    1. Hochman JS, Reynolds HR, Bangalore S, et al. Baseline characteristics and risk profiles of participants in the ISCHEMIA randomized clinical trial [published correction appears in JAMA Cardiol. 2019 May 1;4(5):497]. JAMA Cardiol. 2019;4(3):273–86. https://doi.org/10.1001/jamacardio.2019.0014 .
    1. •• Spertus JA, Jones PG, Maron DJ, et al. Health-status outcomes with invasive or conservative care in coronary disease. N Engl J Med. 2020;382(15):1408–19. https://doi.org/10.1056/NEJMoa1916370 . This study showed that based on the Seattle Angina Questionnaire, patients with stable ischemic heart disease and moderate or severe ischemia randomly assigned to invasive management for coronary artery disease versus medical management experienced greater improvement in their anginal symptoms.
    1. Boden WE, Bhatt DL. Translating the findings of ISCHEMIA into clinical practice: a challenging START. EuroIntervention. 2020;16(12):e953-56. Published 2020 Dec 18. https://doi.org/10.4244/EIJV16I12A174 .
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