ISCHEMIA Trial: Invasive or Medical therapy for Stable CAD

ischemia trial stable cad
2020 ISCHEMIA TRIAL M Initial Invasive or Conservative Strategy for Stable Coronary Disease multicenter, parallel, randomized controlled trial Objective: Tto determine the effect of adding cardiac catheterization (hereafter, angiography) and revascularization when feasible to medical therapy in patients with stable coronary disease and moderate or severe ischemia 5,179 Patients Inclusion criteria: Patients >20 years of age; moderate to severe ischemia on noninvasive stress testing (nuclear ≥10% ischemia; echo ≥3 segments of ischemia; CMR ≥12% ischemia and/or >3 segments with ischemia; ETT ≥1.5 mm STD in ≥2 leads or ≥2 mm STD in single lead at <7 METS with angina) مجھے VS invasive therapy (n = 2,588) 13.3 PRIMARY OUTCOME medical therapy (n = 2,591) CV death, MI, resuscitated cardiac arrest, or hospitalization for UA or HF % P=0.34 SECONDARY OUTCOMES 15.5 11.7 CV death or MI % P=0.21 13.9 All-cause death % 6.4 6.5 P=0.67 Periprocedural myocardial infarction % HR 2.98, 95% CI 1.87-4.74 Conclusion: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. David J. Maron et al. N Engl J Med 2020; 382:1395-1407 M Visualmed