Will ISCHEMIA change our daily practice?

The recently presented ISCHEMIA trial found that, among patients with stable coronary artery disease (CAD) and proven moderate/severe ischemia, an invasive strategy failed to show a significant reduction in cardiovascular events compared to medical therapy alone. We aimed to assess the impact of ISCHEMIA on the daily practice of a public university hospital. We performed a retrospective analysis of the last 1,000 consecutive percutaneous coronary interventions (PCIs) performed in our center and applied the ISCHEMIA exclusion criteria to this population in order to estimate the proportion of these patients that would have been excluded from the trial. Interestingly, only 91 patients (9.1%) did not have any ISCHEMIA exclusion criteria, notably due to the high proportion of acute coronary syndrome (ACS). However, in a sub-analysis based exclusively on patients with stable CAD, 71.6% of the patients undergoing PCI would have been excluded from ISCHEMIA due to the presence of at least one exclusion criteria. In conclusion, in this retrospective analysis of 1,000 PCIs performed in a public university hospital, the majority of PCIs were performed in patients that would have had at least one exclusion criterion from ISCHEMIA. These results suggest that the impact of ISCHEMIA on the real-world practice of a public university hospital might be limited.