6/28/23, 11:38 PM ISCHEMIA Pathway Feedback Search Clinical Topics Home Studies ISCHEMIA ISCHEMIA Disease Coronary artery disease Trial question What is the role of coronary revascularization in patients with stable CAD? Study design Multi-center Open label RCT Population Characteristics of study participants 23.0% female N = 5179 77.0% male 5179 patients (1191 female, 3988 male) Inclusion criteria: patients with stable ischemic heart disease and moderate or severe ischemia on noninvasive testing Key exclusion criteria: recent MI, eGFR < 30 mL/min, LVEF < 35%, LM stenosis > 50%, unacceptable angina Interventions N=2588 invasive management (cath +/- revascularization) N=2591 optimal medical therapy (no routine invasive therapy) Primary outcome CV death, nonfatal MI, resuscitated cardiac arrest, or hospitalization for UA or HF 15.5 % 15.5 13.3 11.6 % https://web.pathway.md/studies/recWIrS9k4aoLQnpA 1/2 6/28/23, 11:38 PM ISCHEMIA Pathway 7.8 % 3.9 % No significant difference 0.0 % Invasive management Optimal medical therapy No significant difference in CV death, nonfatal MI, resuscitated cardiac arrest, or hospitalization for UA or HF (13.3% vs. 15.5%; HR 0.93, 95% CI 0.8 to 1.08) Secondary outcomes No significant difference in death from any cause (6.4% vs. 6.5%; HR 1.05, 95% CI 0.83 to 1.32) No significant difference in cardiovascular death or MI (11.7% vs. 13.9%; HR 0.87, 95% CI 0.66 to 1.15) Borderline significant increase in periprocedural myocardial infarction (13.2% vs. 10.5%; HR 2.98, 95% CI 1.87 to 4.74) Conclusion In patients with stable ischemic heart disease and moderate or severe ischemia on noninvasive testing, invasive management was noninferior to optimal medical therapy with respect to CV death, nonfatal MI, resuscitated cardiac arrest, or hospitalization for UA or HF. Reference David J Maron, Judith S Hochman, Harmony R Reynolds et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease. N Engl J Med. 2020 Apr 9;382(15):1395-1407. Open reference URL https://web.pathway.md/studies/recWIrS9k4aoLQnpA 2/2