Conservative versus invasive stable ischemic heart disease management strategies: What do we plan to learn from the ISCHEMIA trial?

Kathleen A. Cheng-Torres, Karan P. Desai, Mandeep S. Sidhu, David J. Maron, William E. Boden

Research output: Contribution to journalReview articlepeer-review

Abstract

Over the past decade, landmark randomized clinical trials comparing initial management strategies in stable ischemic heart disease (SIHD) have demonstrated no significant reduction in 'hard' end points (all-cause mortality, cardiac death or myocardial infarction) with one strategy versus another. The main advantage derived from early revascularization is improved short-term quality of life. Nonetheless, questions remain regarding how best to manage SIHD patients, such as whether a high-risk subgroup can be identified that may experience a survival or myocardial infarction benefit from early revascularization, and if not, when should diagnostic catheterization and revascularization be performed. The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial is designed to address these questions by randomizing SIHD patients with at least moderate ischemia to an initial conservative strategy of optimal medical therapy or an initial invasive strategy of optimal medical therapy plus cardiac catheterization and revascularization.

Original languageEnglish (US)
Pages (from-to)35-44
Number of pages10
JournalFuture Cardiology
Volume12
Issue number1
DOIs
StatePublished - Jan 2016

Keywords

  • coronary anatomy
  • coronary artery disease
  • myocardial ischemia
  • optimal medical therapy
  • revascularization
  • stable ischemic heart disease

ASJC Scopus subject areas

  • Molecular Medicine
  • Cardiology and Cardiovascular Medicine

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