Learning Cardiology

Q. Which of the following is not true regarding the ISCHEMIA trial ? A. Patients with stable angina were included B. The patients with LM disease were excluded with a CT angiogram C. Early invasive therapy was found to reduce MI and cardiovascular mortality compared to medical therapy in patients with stable angina D. Results are not applicable to patients with severe LV dysfunction Correct answer: C. Early invasive therapy was found to reduce MI and cardiovascular mortality compared to medical therapy in patients with stable angina Explanation: https://www.learningcardiology.com/2020/06/ischemia-trial.html

Background: We don't know the optimum mode of therapy for patients with stable ischemic heart disease along with moderate to severe myocardial ischemia on non-invasive stress testing. Routine early invasive therapy was compared with optimal medical therapy in this trial. Study design: Patients: Stable ischemic heart disease with moderate to severe ischemia on stress testing. All patients underwent CT coronary angiogram prior to inclusion in the trial to rule out significant LM disease. Exclusion: - LM stenosis >50% (on CT coronary angiogram) - Recent MI - LVEF < 35% - Unacceptable angina at baseline - NYHA class III and IV heart failure - Prior PCI or CABG within last one year Groups: Routine invasive therapy (n = 2588) vs initial optimal medical therapy (n= 2591) Interventions in both groups: - Routine invasive group: Patients underwent angiography followed by PCI or CABG as per the anatomy. - Medical therapy group: All patients were put on initial medi