International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial: Rationale and design

American Heart Journal
ISCHEMIA Trial Research GroupYves Rosenberg

Abstract

Prior trials comparing a strategy of optimal medical therapy with or without revascularization have not shown that revascularization reduces cardiovascular events in patients with stable ischemic heart disease (SIHD). However, those trials only included participants in whom coronary anatomy was known prior to randomization and did not include sufficient numbers of participants with significant ischemia. It remains unknown whether a routine invasive approach offers incremental value over a conservative approach with catheterization reserved for failure of medical therapy in patients with moderate or severe ischemia. The ISCHEMIA trial is a National Heart, Lung, and Blood Institute supported trial, designed to compare an initial invasive or conservative treatment strategy for managing SIHD patients with moderate or severe ischemia on stress testing. Five thousand one-hundred seventy-nine participants have been randomized. Key exclusion criteria included estimated glomerular filtration rate (eGFR) <30 mL/min, recent myocardial infarction (MI), left ventricular ejection fraction <35%, left main stenosis >50%, or unacceptable angina at baseline. Most enrolled participants with normal renal function first underwent blinded coronary c...Continue Reading

Citations

Jul 12, 2018·Current Opinion in Cardiology·Bobby YanagawaJohn D Puskas
Jan 4, 2019·European Heart Journal·Yusuke Yoshikawa, Takeshi Kimura
Feb 19, 2019·Circulation. Cardiovascular Quality and Outcomes·Srinath Adusumalli, Jay Giri
Feb 28, 2019·JAMA Cardiology·Judith S HochmanUNKNOWN ISCHEMIA Research Group
Nov 22, 2018·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·João V Vitola
Aug 6, 2019·Annals of Internal Medicine·Daniel Katz, Michael C Gavin
Jun 28, 2019·Current Opinion in Cardiology·Shuangbo LiuAkshay Bagai
Nov 14, 2019·Circulation. Cardiovascular Quality and Outcomes·Jonathan D NewmanDavid J Maron
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Jan 4, 2020·Journal of Korean Medical Science·Min Chul Kim, Youngkeun Ahn
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