Initial Invasive or Conservative Strategy for Stable Coronary Disease

This large, multicenter, randomized trial (ISCHEMIA) evaluated whether an initial invasive strategy (angiography and revascularization when feasible) added to medical therapy was superior to medical therapy alone for patients with stable coronary artery disease and moderate or severe ischemia. Over a median 3.2-year follow-up of 5,179 patients, no significant difference was found in the primary composite outcome of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. An early increase in procedural myocardial infarctions was offset by later reductions in spontaneous events in the invasive group. The study concluded that an initial invasive approach did not significantly improve major cardiovascular outcomes over conservative management.

This large, multicenter, randomized trial (ISCHEMIA) evaluated whether an initial invasive strategy (angiography and revascularization when feasible) added to medical therapy was superior to medical therapy alone for patients with stable coronary artery disease and moderate or severe ischemia. Over a median 3.2-year follow-up of 5,179 patients, no significant difference was found in the primary composite outcome of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. An early increase in procedural myocardial infarctions was offset by later reductions in spontaneous events in the invasive group. The study concluded that an initial invasive approach did not significantly improve major cardiovascular outcomes over conservative management.