Although the ISCHEMIA trial is a touchstone in the management of patients with stable ischemic heart disease (SIHD), its population does not reflect most patients seen in US practice today, new research suggests.
The 2019 landmark trial challenged the prevailing belief that offering an initial invasive strategy may confer a benefit in stable patients with moderate or severe ischemia on stress testing. Revascularization, however, produced no significant advantage over optimal medical therapy alone for the hard endpoints of death and myocardial infarction (MI) over 3 years, albeit with better symptom relief and quality of life for those with angina at baseline.
What isn't well recognized is that the trial excluded a significant proportion of patients routinely considered for revascularization, such as those with acute coronary syndromes (ACS), cardiac arrest, cardiogenic shock, ejection fraction less than 35%, left main disease, or end-stage renal disease; and recruited only 16.5% of its participants from the US, observed Saurav Chatterjee, MD, author of the new analysis.
To determine the proportion of stable SIHD patients in the US who meet ISCHEMIA inclusion criteria, Chatterjee and colleagues performed cross-sectional analyses of 927,011 patients undergoing percutaneous coronary intervention (PCI) in the US from October 2017 to June 2019 in the National Cardiovascular Data Registry (NCDR) CathPCI Registry.
