| Contributors: |
Pracon, R.; Spertus, J. A.; Broderick, S.; Bangalore, S.; Rockhold, F. W.; Ruzyllo, W.; Demchenko, E.; Nageh, T.; Grossman, G. B.; Mavromatis, K.; Manjunath, C. N.; Smanio, P. E. P.; Stone, G. W.; Mancini, G. B. J.; Boden, W. E.; Newman, J. D.; Reynolds, H. R.; Hochman, J. S.; Maron, D. J.; Doan, J.; Linefsky, J.; Lee, R.; Patel, R.; Miller, T.; Cho, S. Y.; Milbrandt, S.; Shelstad, D.; Banerjee, S.; Kamath, P.; Tejani, I.; Donnino, R. M.; Phillips, L. M.; Saric, M.; Abdul-Nour, K.; Schley, A.; Golden, H.; Stone, P. H.; Osseni, H.; Wiyarand, C.; Douglass, P.; Pomeroy, H.; Craft, A.; Harvey, B.; Jang, J. J.; Anaya, O.; Yee, G.; Goold, P.; Weitz, S.; Giovannone, S.; Pritchard, L.; Arnold, S.; Gans, R.; O'Keefe, J. H.; Kennedy, P.; Shapiro, M. D.; Ganesan, S.; Schlichting, D.; Naher, A.; Fein, S. A.; Stewart, W. L.; Torosoff, M. T.; Salmi, K. M.; Lyubarova, R.; Mookherjee, S.; Drzymalski, K.; Mcfalls, E. O.; Garcia, S. A.; Bertog, S. C.; Johnson, D. K.; Siddiqui, R. A.; Herrmann, R. R.; Ishani, A.; Hansen, R. A.; Khouri, M. G.; Arges, K.; Lefevre, M.; Tomfohr, J.; Goldberg, J. L.; Byrne, K. A.; Zappernick, T.; Goldweit, R.; Canada, S.; Kakade, M.; Mieses, P.; Cohen, R. A.; Mirrer, B.; Navarro, V.; Rantinella, M.; Rodriguez, J.; Mancilla, O.; Winchester, D. E.; Stinson, S.; Kronenberg, M.; Weyand, T.; Rogal, P. |
| Description: |
BACKGROUND: ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) did not find an overall reduction in cardiovascular events with an initial invasive versus conservative management strategy in chronic coronary disease; however, there were conservative strategy participants who underwent invasive coronary angiography early postrandomization (within 6 months). Identifying factors associated with angiography in conservative strategy participants will inform clinical decision-making in patients with chronic coronary disease. METHODS: Factors independently associated with angiography performed within 6 months of randomization were identified using Fine and Gray proportional subdistribution hazard models, including demographics, region of randomization, medical history, risk factor control, symptoms, ischemia severity, coronary anatomy based on protocol-mandated coronary computed tomography angiography, and medication use. RESULTS: Among 2591 conservative strategy participants, angiography within 6 months of randomization occurred in 8.7% (4.7% for a suspected primary end point event, 1.6% for persistent symptoms, and 2.6% due to protocol nonadherence) and was associated with the following baseline characteristics: enrollment in Europe versus Asia (hazard ratio [HR], 1.81 [95% CI, 1.14-2.86]), daily and weekly versus no angina (HR, 5.97 [95% CI, 2.78-12.86] and 2.63 [95% CI, 1.51-4.58], respectively), poor to fair versus good to excellent health status (HR, 2.02 [95% CI, 1.23-3.32]) assessed with Seattle Angina Questionnaire, and new/more frequent angina prerandomization (HR, 1.80 [95% CI, 1.34-2.40]). Baseline low-density lipoprotein cholesterol 70% on coronary computed tomography angiography. CONCLUSIONS: Among ISCHEMIA participants randomized to the ... |