| Title: |
Survival After Invasive or Conservative Management of Stable Coronary Disease. |
| Authors: |
Hochman, JS; Anthopolos, R; Reynolds, HR; Bangalore, S; Xu, Y; O'Brien, SM; Mavromichalis, S; Chang, M; Contreras, A; Rosenberg, Y; Kirby, R; Bhargava, B; Senior, R; Banfield, A; Goodman, SG; Lopes, RD; Pracoń, R; López-Sendón, J; Maggioni, AP; Newman, JD; Berger, JS; Sidhu, MS; White, HD; Troxel, AB; Harrington, RA; Boden, WE; Stone, GW; Mark, DB; Spertus, JA; Maron, DJ; ISCHEMIA-EXTEND Research Group |
| Publisher Information: |
Lippincott, Williams & Wilkins |
| Publication Year: |
2022 |
| Collection: |
Queen Mary University of London: Queen Mary Research Online (QMRO) |
| Subject Terms: |
catheterization; coronary artery bypass; medication therapy management; myocardial ischemia; percutaneous coronary intervention; Humans; Female; Aged; Male; Conservative Treatment; Bayes Theorem; Coronary Artery Disease; Acute Coronary Syndrome; Treatment Outcome |
| Description: |
BACKGROUND: The ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) compared an initial invasive versus an initial conservative management strategy for patients with chronic coronary disease and moderate or severe ischemia, with no major difference in most outcomes during a median of 3.2 years. Extended follow-up for mortality is ongoing. METHODS: ISCHEMIA participants were randomized to an initial invasive strategy added to guideline-directed medical therapy or a conservative strategy. Patients with moderate or severe ischemia, ejection fraction ≥35%, and no recent acute coronary syndromes were included. Those with an unacceptable level of angina were excluded. Extended follow-up for vital status is being conducted by sites or through central death index search. Data obtained through December 2021 are included in this interim report. We analyzed all-cause, cardiovascular, and noncardiovascular mortality by randomized strategy, using nonparametric cumulative incidence estimators, Cox regression models, and Bayesian methods. Undetermined deaths were classified as cardiovascular as prespecified in the trial protocol. RESULTS: Baseline characteristics for 5179 original ISCHEMIA trial participants included median age 65 years, 23% women, 16% Hispanic, 4% Black, 42% with diabetes, and median ejection fraction 0.60. A total of 557 deaths accrued during a median follow-up of 5.7 years, with 268 of these added in the extended follow-up phase. This included a total of 343 cardiovascular deaths, 192 noncardiovascular deaths, and 22 unclassified deaths. All-cause mortality was not different between randomized treatment groups (7-year rate, 12.7% in invasive strategy, 13.4% in conservative strategy; adjusted hazard ratio, 1.00 [95% CI, 0.85-1.18]). There was a lower 7-year rate cardiovascular mortality (6.4% versus 8.6%; adjusted hazard ratio, 0.78 [95% CI, 0.63-0.96]) with an initial invasive strategy but a higher 7-year rate of noncardiovascular mortality (5.6% ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
8 - 19 |
| Language: |
English |
| Relation: |
Circulation; https://qmro.qmul.ac.uk/xmlui/handle/123456789/101278 |
| DOI: |
10.1161/CIRCULATIONAHA.122.062714 |
| Availability: |
https://qmro.qmul.ac.uk/xmlui/handle/123456789/101278; https://doi.org/10.1161/CIRCULATIONAHA.122.062714 |
| Rights: |
© 2022 American Heart Association, Inc. |
| Accession Number: |
edsbas.83F9C48A |
| Database: |
BASE |