- For stable coronary artery disease (CAD), a conservative approach does not increase risk for ischemic events or mortality compared with an initial invasive strategy.
Why this matters
- These results from the ISCHEMIA trial might ease concerns about postponing “elective” procedures as centers make space for treating COVID-19 cases.
- 3.2-year median follow-up.
- Early outcomes were 5.3% cumulative event rate with invasive treatment vs 3.4% with conservative (difference, 1.9 [95% CI, 0.8-3.0] percentage points).
- At 5 years, these rates were 16.4% vs 18.2% (difference, −1.8 [95% CI, −4.7 to 1.0] percentage points).
- An analysis adjusting for the definition of myocardial infarction found even more similar mortality: 145 with an invasive strategy vs 144 with a conservative approach (HR, 1.05; 95% CI, 0.83-1.32).
- Invasive revascularization approaches (79%) were percutaneous coronary intervention (74%) and coronary artery bypass graft (26%).
- 34% who initiated with conservative treatment shifted to invasive before the primary outcome event.
- No evidence of difference in event-free time between groups.
- 5179 patients (320 sites, 37 countries) were randomly allocated to initial invasive or conservative treatment (medical therapy alone), July 26, 2012 through January 31, 2018.
- Primary outcome: composite of cardiovascular events/death.
- Funding: National Heart, Lung, and Blood Institute; Arbor Pharmaceuticals; AstraZeneca Pharmaceuticals; others.
- Event rates beyond “modest” median follow-up not known.