Name:
ISCHEMIA Trial's Long-Awaited Results
Description:
ISCHEMIA Trial's Long-Awaited Results
Thumbnail URL:
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Duration:
T00H05M04S
Embed URL:
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Content URL:
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's, the Heart Board Review, and other online resources available only through accesscardiology.com. >> For the past several years, we've been debating and trying to get evidence based, whether or not optimal medical therapy or invasive strategy would be best for patients with chronic stable angina who continue to have moderate or even very severe ischemia. Dr. Bernie here, welcoming you to Practice Impact Extra.
There's been a lot of discussion, even debate, about the value of optimal medical management and treatment versus interventional PCI in the treatment of chronic stable angina. And we've been waiting for a while, almost 10 years, for the results of the ISCHEMIA trial, and this long-anticipated trial was eventually and has been reported at the American Heart meeting in November of 2019. It's somewhat similar to a trial, the COURAGE trial, that was published in 2007.
This trial enrolled patients with stable angina, and the results of that trial showed no differences in death or myocardial infarction with optimal medical management versus revascularization with PCI. The problem was it left a question about what about the patients with moderate or more severe ischemia unanswered. The ISCHEMIA trial goal was to evaluate routine invasive therapy compared with optimal medical management among patients with stable ischemic heart disease with moderate to severe myocardial ischemia.
Simply put, if you have chronic stable angina, should you have an interventional procedure? The trial randomized 5000 chronic stable patients -- those with acute coronary syndromes were excluded -- and they were randomized to optimal medical treatment or invasive strategy. Patients with intolerable angina or left main disease on CTA were excluded. The primary outcome, CV death, myocardial infarction, resuscitated cardiac arrest, or hospitalization for unstable angina or heart failure, was also assessed as primary outcome.
This trial failed to show that routine invasive therapy was associated with a reduction in major adverse ischemic events compared to optimal medical treatment in patients with stable angina with moderate ischemia. What's interesting, when you look at the slides that were presented, if you see the curves at 2 years, the two groups look very similar, but the curves begin to separate at 4 years, demonstrating a benefit to the invasive arm with a reduction in spontaneous myocardial infarction.
In addition, in this presentation and publication, there was a subanalysis of the quality of life and was reported because certainly it impacts significantly on the patient and their cardiologist's decision for treatment options. The results of the quality of life survey demonstrated that PCI provided early and sustained benefit in quality of life measures, and was related to the amount of baseline angina that patients had and even those who had mild angina.
The more angina symptoms the patient had, the better the quality of life improvement was noted. So, what does the ISCHEMIA trial tell us? This is my thoughts. Certainly, patients with chronic stable angina with moderate or severe ischemia, should have their coronary anatomy assessed to rule out left main with CTA. And if FFR was available, that could be very helpful as well. Patients with inclusion criteria for the ISCHEMIA trial need to begin medical management, and aggressively optimized to ensure guideline targets are met, particularly related to blood pressure, cholesterol, LDL levels, and maybe anti-inflammatory drugs in the future, along with lifestyle changes.
Should a patient remain symptomatic, I would recommend invasive cardiac catheterization laboratory evaluation be considered for revascularization with the goal to improve their quality of life. Thanks for joining me, and see you next time on Practice Impact Extra. >> We hope you enjoyed this podcast from McGraw Hill. Subscribers to Access Cardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features.
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