Key result
Invasive revascularization achieves ~40% more complete angina relief at 12 months vs conservative therapy.
Why the study?
Patients with chronic coronary disease experience less angina with revascularization plus optimal medical therapy versus medical therapy alone, but their individual likelihood of complete angina relief with each approach remains unclear.
Does invasive management using revascularization plus optimal medical therapy improve complete angina relief at 12 months compared to conservative therapy with optimal medical therapy alone in symptomatic patients with chronic coronary disease?
RCT (n=2,534)
Yes
Does invasive management using revascularization plus optimal medical therapy improve complete angina relief at 12 months compared to conservative therapy with optimal medical therapy alone in symptomatic patients with chronic coronary disease?
In symptomatic patients with chronic coronary disease, revascularization provides higher rates of complete angina relief at 12 months compared to conservative therapy (70% vs 50%), though achieving complete angina relief does not impact long-term rates of cardiovascular death or myocardial infarction.
Supports symptom relief with revascularization in chronic coronary disease; leaves open effects on hard outcomes and requires randomized confirmation.
BACKGROUND: Patients with chronic coronary disease experience less angina with revascularization plus optimal medical therapy compared with optimal medical therapy alone. However, patients may prefer to better understand their individual likelihood of complete angina relief associated with each treatment approach before selecting a strategy. We therefore sought to determine the incidence, predictors, and outcomes of complete angina relief in symptomatic patients treated with invasive management using revascularization plus optimal medical therapy or conservative therapy with optimal medical therapy alone in the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial. METHODS: Angina was assessed using the Seattle Angina Questionnaire Angina Frequency (AF) score. We analyzed patients in the invasive management treatment arm with angina at baseline (Seattle Angina Questionnaire Angina Frequency <100) who underwent revascularization and all patients in the conservative therapy arm with angina at baseline. The primary outcome was angina status at 12 months defined as a Seattle Angina Questionnaire Angina Frequency=100 (complete angina relief) or Seattle Angina Questionnaire Angina Frequency <100 (persistent angina). The association of angina status with the composite of cardiovascular death/myocardial infarction was assessed at 5 years. RESULTS: Among 1376 patients in the conservative therapy arm with angina at baseline, 50% experienced complete angina relief at 12 months. Independent predictors included older age, male sex, recent angina onset, and less baseline angina. Among 1158 patients who underwent revascularization, 70% achieved complete angina relief. Predictors included younger age, nonsmoking, coronary artery bypass graft, and less baseline angina. Cardiovascular death/myocardial infarction rates at 5 years did not differ between patients with or without complete angina relief. CONCLUSIONS: Complete angina relief at 12 months in symptomatic patients with chronic coronary disease was achieved in 70% of patients undergoing revascularization and 50% of patients treated ith conservative therapy and did not influence cardiovascular death/myocardial infarction outcomes. REGISTRATION: https://ischemiatrial.org/; ISCHEMIA Trial. Accession Number HLB02742323a.
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Singh et al. (2025) conducted an RCT in chronic coronary disease (n=2,534). Invasive management using revascularization plus optimal medical therapy vs. Conservative therapy with optimal medical therapy alone was evaluated on angina status at 12 months defined as a Seattle Angina Questionnaire Angina Frequency=100 (complete angina relief) or <100 (persistent angina). Invasive management with revascularization achieved complete angina relief at 12 months in 70% of symptomatic patients with chronic coronary disease, compared to 50% with conservative therapy.
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