Jamal Choudhary1, Sarah Chiu2, Priyanka Bhugra3, Behnood Bikdeli4,5,6, Azhar Supariwala7, Rajiv Jauhar8,9,10, Saurav Chatterjee11. 1. Frank H. Netter, MD School of Medicine, Quinnipiac University, North Haven, CT, USA. 2. Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA. 3. Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, USA. 4. Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 5. Yale/YNHH Center for Outcomes Research & Evaluation, New Haven, CT, USA. 6. Cardiovascular Research Foundation (CRF), New York, NY, USA. 7. South Shore University Hospital, Northwell Health, Zucker School of Medicine, New York, NY, USA. 8. Sandra Atlas Bass Heart Hospital, Manhasset, NY, 11030, USA. 9. North Shore University Hospita, Manhasset, NY, 11030, USA. 10. Hofstra Northwell School of Medicine, Hempstead, NY, 11549, USA. 11. Division of Cardiovascular Medicine, Long Island Jewish Medical Center, Northwell Health, Zucker School of Medicine, 270-05 76th Street, New Hyde Park, New York, NY, USA. sauravchatterjeemd@gmail.com.
Abstract
PURPOSE OF REVIEW: To identify key strengths and weaknesses of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial and explore its clinical implications in patients with stable ischemic heart disease. RECENT FINDINGS: Previous studies have shown inconsistent benefit of early angiography and revascularization in patients with stable ischemic heart disease. The ISCHEMIA trial showed no significant reduction in mortality or cardiovascular outcomes in patients undergoing early angiography and revascularization with guideline-directed medical therapy compared to patients on medical therapy alone in specific patient population with stable coronary artery disease. The ISCHEMIA trial provides insights into invasive versus pharmacological treatment for patients with stable ischemic heart disease. Though it may have reduced applicability given its broad exclusion criteria, it offers useful information about the utility of non-invasive imaging modalities for selecting optimal revascularization candidates.
PURPOSE OF REVIEW: To identify key strengths and weaknesses of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial and explore its clinical implications in patients with stable ischemic heart disease. RECENT FINDINGS: Previous studies have shown inconsistent benefit of early angiography and revascularization in patients with stable ischemic heart disease. The ISCHEMIA trial showed no significant reduction in mortality or cardiovascular outcomes in patients undergoing early angiography and revascularization with guideline-directed medical therapy compared to patients on medical therapy alone in specific patient population with stable coronary artery disease. The ISCHEMIA trial provides insights into invasive versus pharmacological treatment for patients with stable ischemic heart disease. Though it may have reduced applicability given its broad exclusion criteria, it offers useful information about the utility of non-invasive imaging modalities for selecting optimal revascularization candidates.
Entities:
Keywords:
Cardiac catheterization; Guideline-directed medical therapy; Ischemic heart disease; Revascularization
Authors: Renato D Lopes; Karen P Alexander; Susanna R Stevens; Harmony R Reynolds; Gregg W Stone; Ileana L Piña; Frank W Rockhold; Ahmed Elghamaz; Jose Luis Lopez-Sendon; Pedro S Farsky; Alexander M Chernyavskiy; Ariel Diaz; Denis Phaneuf; Mark A De Belder; Yi-Tong Ma; Luis A Guzman; Michel Khouri; Alessandro Sionis; Derek J Hausenloy; Rolf Doerr; Joseph B Selvanayagam; Aldo Pietro Maggioni; Judith S Hochman; David J Maron Journal: Circulation Date: 2020-08-29 Impact factor: 29.690