ISCHEMIA-CKD Trial Summary: CAD Management in Advanced CKD

ischemia ckd trial

2020 ISCHEMIA-CKD TRIAL Management of coronary disease in patients with advanced kidney disease international, randomized controlled trial Objective: To compare the effectiveness of routine invasive therapy with optimal medical therapy among patients with stable coronary disease & advanced chronic kidney disease 777 Patients Inclusion criteria: Patients >20 years with at least moderate ischemia on noninvasive stress testing; End-stage renal disease on dialysis or eGFR <30mL/min/1.73 sq.m + VS Invasive strategy (n=388) Conservative strategy (n=389) PRIMARY OUTCOME 36.4 Death or nonfatal myocardial infarction % HR 1.01; 95% CI, 0.79 to 1.29; P=0.95 36.7 38.5 SECONDARY OUTCOMES Composite of death, nonfatal MI, or hospitalization for unstable angina,HF, or resuscitated cardiac arrest %. HR 1.01; 95% CI, 0.79 to 1.29 39.7 Stroke % 6.4 1.6 HR 3.76; 95% CI, 1.52 to 9.32; P=0.004 Death from any cause or initiation of 44.8 dialysis % 42.4 HR 1.48; 95% CI, 1.04 to 2.11; P=0.03 Conclusion: Initial invasive strategy did not reduce the risk of death or nonfatal myocardial infarction or improve angina-related health status as compared with an initial conservative strategy S Bangalore et al. NEJM 2020; 382:1608-1618