Survival After Invasive or Conservative Management of Stable Coronary Disease
Why the study?
The ISCHEMIA trial showed no major difference in most outcomes at a median of 3.2 years, prompting extended follow-up to evaluate long-term mortality.
Does an initial invasive strategy reduce all-cause mortality in patients with chronic coronary disease and moderate or severe ischemia compared to a conservative strategy?
Population
5179 patients with chronic coronary disease, moderate or severe ischemia, and ejection fraction ≥35%
Comparison
Initial invasive strategy plus guideline-directed medical therapy vs conservative strategy
Design
Randomized controlled trial extended follow-up
Follow-up
Median 5.7 years
Authors
Discussion
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Member takes
Implication
Supports initial conservative strategy in stable chronic coronary disease; reinforces guideline-directed medical therapy over routine invasive approaches.
Structured PICO
Does an initial invasive strategy reduce all-cause mortality in patients with chronic coronary disease and moderate or severe ischemia compared to a conservative strategy?
P
Population
5,179 participants with chronic coronary disease and moderate or severe ischemia, ejection fraction ≥35%, and no recent acute coronary syndromes. Excluded: unacceptable level of angina. Median age 65 years, 23% women, 16% Hispanic, 4% Black, 42% with diabetes, median ejection fraction 0.60.
I
Intervention
Initial invasive strategy added to guideline-directed medical therapy
C
Comparator
Initial conservative strategy (guideline-directed medical therapy)
O
Outcome
All-cause mortalityhard clinical
Extended follow-up of the ISCHEMIA trial demonstrates that an initial invasive strategy does not improve all-cause mortality compared with a conservative strategy at a median of 5.7 years, despite a reduction in cardiovascular mortality offset by an increase in noncardiovascular mortality.
Cite This Study
Hochman et al. (2022) studied this question.