Myocardial Infarction in the ISCHEMIA Trial
Key result
Invasive strategy reduces type 1 MI events versus conservative management in stable ischemic heart disease.
Why the study?
In the ISCHEMIA trial, MI was the most frequent component of composite cardiovascular end points, prompting prespecified evaluation of MI type, frequency, and prognosis using two distinct MI definitions.
Does an initial invasive strategy alter the frequency and type of myocardial infarction compared to a conservative strategy in patients with stable ischemic heart disease and moderate/severe myocardial ischemia?
Population
Patients with stable ischemic heart disease and moderate/severe myocardial ischemia
Comparison
Initial invasive strategy vs conservative strategy
Design
Prespecified trial analysis
Follow-up
5-year
Authors
Discussion
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Member takes
Implication
Initial invasive strategy lowers type 1 MI and linked CV death risk in stable IHD; extends neutral primary results via MI subtype differentiation.
Structured PICO
Does an initial invasive strategy alter the frequency and type of myocardial infarction compared to a conservative strategy in patients with stable ischemic heart disease and moderate/severe myocardial ischemia?
P
Population
Patients with stable ischemic heart disease and moderate/severe myocardial ischemia
I
Intervention
Initial invasive strategy
C
Comparator
Conservative strategy
O
Outcome
MI type, frequency, and prognosis by treatment assignment using 2 MI definitions (primary using CK-MB and secondary using cardiac troponin)hard clinical
An initial invasive strategy in stable ischemic heart disease reduces the risk of type 1 MI, which is associated with subsequent cardiovascular death, but increases the risk of procedural MI.
Cite This Study
Chaitman et al. (2020) studied this question. In patients with stable ischemic heart disease, type 1 MI events were more frequent with a conservative strategy than invasive strategy, associated with higher cardiovascular death risk.