Invasive treatments in patients with stable coronary heart disease have no advantages when compared with optimal drug therapy. Such results were obtained in a large randomized trial – ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches). ISCHEMIA investigators at 320 sites in 37 countries randomly assigned 5179 stable patients with moderate or severe ischemia on stress imaging or exercise tolerance testing to early invasive coronary catheterization followed by percutaneous coronary intervention (PCI) or coronary bypass surgery, if feasible, plus optimal medical therapy (OMT) or to OMT alone. The trial enrolled 8518 patients, but to avoid the charge of referral bias leveled against prior studies, randomization was done after blinded computed tomography angiography (CTA) to identify and exclude those with left main disease (LMD) (≥ 50% stenosis) or without obstructive coronary artery disease (CAD) (<50% stenosis in all major coronaries). Over a median of 3.3 years follow-up. The results of the study showed that the incidence of myocardial infarction (MI), cardiac arrest, hospitalization due to unstable angina or heart failure, as well as mortality from CVD was 13.3% in the first group and 15.5% in the second (for MI and CVD mortality was 11.7% and 13.9%, respectively). Mortality from all causes did not differ significantly between groups: 6.4% and 6.5%, respectively. The use of invasive methods was associated with an increase in the risk of MI of types 4a and 5 over the next 6 months, but at the same time they were associated with a decrease in the risk of spontaneous MI for 4 years and with an improvement in the quality of life of patients.
https://www.medscape.com/viewarticle/921463
American Heart Association (AHA) Scientific Sessions 2019: Presented November 16, 2019.
