Survival After Invasive or Conservative Management of Stable Coronary Disease. Issue 1 (6th November 2022)

• Record Type: Journal Article
• Authors: Hochman, Judith S.; Anthopolos, Rebecca; Reynolds, Harmony R.; Bangalore, Sripal; Xu, Yifan; O'Brien, Sean M.; Mavromichalis, Stavroula; Chang, Michelle; Contreras, Aira; Rosenberg, Yves; Kirby, Ruth; Bhargava, Balram; Senior, Roxy; Banfield, Ann; Goodman, Shaun G.; Lopes, Renato D.; Pracoń, Radosław; López-Sendón, José; Maggioni, Aldo Pietro; Newman, Jonathan D.; Berger, Jeffrey S.; Sidhu, Mandeep S.; White, Harvey D.; Troxel, Andrea B.; Harrington, Robert A.; Boden, William E.; Stone, Gregg W.; Mark, Daniel B.; Spertus, John A.; Maron, David J.
• Other Names: Hochman Judith S. author non-byline.; Maron David J. author non-byline.; Reynolds Harmony R. author non-byline.; Bangalore Sripal author non-byline.; Mavromichalis Stavroula author non-byline.; Chang Michelle author non-byline.; Contreras Aira author non-byline.; Esquenazi-Karonika Shari author non-byline.; Gilsenan Margaret author non-byline.; Gwiszcz Ewelina author non-byline.; Mathews Patenne author non-byline.; Mohamed Samaa author non-byline.; Naumova Anna author non-byline.; Roberts Arline author non-byline.; VanLoo Kerrie author non-byline.; Anthopolos Rebecca author non-byline.; Xu Yifan author non-byline.; Troxel Andrea B. author non-byline.; Lu Ying author non-byline.; Huang Zhen author non-byline.; Broderick Samuel author non-byline.; Guzmán Luis author non-byline.; Selvanayagam Joseph author non-byline.; Lopes Renato D. author non-byline.; Goodman Shaun G. author non-byline.; Steg Gabriel author non-byline.; Juliard Jean-Michel author non-byline.; Doerr Rolf author non-byline.; Keltai Matyas author non-byline.; Bhargava Balram author non-byline.; Thomas Boban author non-byline.; Sharir Tali author non-byline.; Nikolsky Eugenia author non-byline.; Maggioni Aldo P. author non-byline.; Kohsaka Shun author non-byline.; Escobedo Jorge author non-byline.; White Harvey D. author non-byline.; Pracoń Radosław author non-byline.; Bockeria Olga author non-byline.; López-Sendón José author non-byline.; Held Claes author non-byline.; Senior Roxy author non-byline.; Banfield Ann author non-byline.; Shaw Leslee J. author non-byline.; Phillips Lawrence author non-byline.; Berman Daniel author non-byline.; Kwong Raymond Y. author non-byline.; Picard Michael H. author non-byline.; Chaitman Bernard R. author non-byline.; Ali Ziad author non-byline.; Min James author non-byline.; Mancini G.B. John author non-byline.; Leipsic Jonathon author non-byline.; Guzmán Luis author non-byline.; Hillis Graham author non-byline.; Thambar Suku author non-byline.; Joseph Majo author non-byline.; Selvanayagam Joseph author non-byline.; Beltrame John author non-byline.; Lang Irene author non-byline.; Schuchlenz Herwig author non-byline.; Huber Kurt author non-byline.; Goetschalckx Kaatje author non-byline.; Hueb Whady author non-byline.; Caramori Paulo Ricardo author non-byline.; de Quadros Alexandre author non-byline.; Smanio Paola author non-byline.; Mesquita Claudio author non-byline.; Lopes Renato D. author non-byline.; Vitola João author non-byline.; Marin-Neto José author non-byline.; da Silva Expedito Ribeiro author non-byline.; Tumelero Rogério author non-byline.; Andrade Marianna author non-byline.; Alves Alvaro Rabelo author non-byline.; Dall'Orto Frederico author non-byline.; Polanczyk Carisi author non-byline.; Figueiredo Estevão author non-byline.; Howarth Andrew author non-byline.; Gosselin Gilbert author non-byline.; Cheema Asim author non-byline.; Bainey Kevin author non-byline.; Phaneuf Denis author non-byline.; Diaz Ariel author non-byline.; Garg Pallav author non-byline.; Mehta Shamir author non-byline.; Wong Graham author non-byline.; Lam Andy author non-byline.; Cha James author non-byline.; Galiwango Paul author non-byline.; Uxa Amar author non-byline.; Chow Benjamin (Ben) author non-byline.; Hameed Adnan author non-byline.; Udell Jacob author non-byline.; Cheema Asim author non-byline.; Hamid Magdy author non-byline.; Hauguel-Moreau Marie author non-byline.; Furber Alain author non-byline.; Goube Pascal author non-byline.; Steg Philippe-Gabriel author non-byline.; Barone-Rochette Gilles author non-byline.; Thuaire Christophe author non-byline.; Slama Michel author non-byline.; Doerr Rolf author non-byline.; Nickenig Georg author non-byline.; Bekeredjian Raffi author non-byline.; Schulze P. Christian author non-byline.; Merkely Bela author non-byline.; Fontos Geza author non-byline.; Vértes András author non-byline.; Varga Albert author non-byline.; Bhargava Balram author non-byline.; Kumar Ajit author non-byline.; Nair Rajesh G. author non-byline.; Grant Purvez author non-byline.; Manjunath Cholenahally author non-byline.; Moorthy Nagaraja author non-byline.; Satheesh Santhosh author non-byline.; Nath Ranjit Kumar author non-byline.; Wander Gurpreet author non-byline.; Christopher Johann author non-byline.; Dwivedi Sudhanshu author non-byline.; Oomman Abraham author non-byline.; Mathur Atul author non-byline.; Gadkari Milind author non-byline.; Naik Sudhir author non-byline.; Punnoose Eapen author non-byline.; Kachru Ranjan author non-byline.; Christopher Johann author non-byline.; Kaul Upendra author non-byline.; Sharir Tali author non-byline.; Kerner Arthur author non-byline.; Tarantini Giuseppe author non-byline.; Perna Gian Piero author non-byline.; Racca Emanuela author non-byline.; Mortara Andrea author non-byline.; Monti Lorenzo author non-byline.; Briguori Carlo author non-byline.; Leone Gianpiero author non-byline.; Amati Roberto author non-byline.; Salvatori Mauro author non-byline.; Di Chiara Antonio author non-byline.; Calabro Paolo author non-byline.; Galvani Marcello author non-byline.; Provasoli Stefano author non-byline.; Fukuda Keiichi author non-byline.; Kohsaka Shun author non-byline.; Nakano Shintaro author non-byline.; Laucevicius Aleksandras author non-byline.; Kedev Sasko author non-byline.; Khairuddin Ahmad author non-byline.; Escobedo Jorge author non-byline.; Riezebos Robert author non-byline.; Timmer Jorik author non-byline.; Heald Spencer author non-byline.; Stewart Ralph author non-byline.; Ramos Walter Mogrovejo author non-byline.; Demkow Marcin author non-byline.; Mazurek Tomasz author non-byline.; Drozdz Jarozlaw author non-byline.; Szwed Hanna author non-byline.; Witkowski Adam author non-byline.; Ferreira Nuno author non-byline.; Pinto Fausto author non-byline.; Ramos Ruben author non-byline.; Popescu Bogdan author non-byline.; Pop Calin author non-byline.; Bockeria Leo author non-byline.; Bockeria Olga author non-byline.; Demchenko Elena author non-byline.; Romanov Alexander author non-byline.; Bershtein Leonid author non-byline.; Jizeeri Ahmed author non-byline.; Stankovic Goran author non-byline.; Apostolovic Svetlana author non-byline.; Adjic Nada Cemerlic author non-byline.; Zdravkovic Marija author non-byline.; Beleslin Branko author non-byline.; Dekleva Milica author non-byline.; Davidovic Goran author non-byline.; Chua Terrance author non-byline.; Foo David author non-byline.; Poh Kian Keong author non-byline.; Ntsekhe Mpiko author non-byline.; Sionis Alessandro author non-byline.; Marin Francisco author non-byline.; Miró Vicente author non-byline.; López-Sendón José author non-byline.; Blancas Montserrat Gracida author non-byline.; González-Juanatey José author non-byline.; Fernández-Avilés Francisco author non-byline.; Peteiro Jesús author non-byline.; Luena Jose Enrique Castillo author non-byline.; Held Claes author non-byline.; Aspberg Johannes author non-byline.; Rossi Mariagrazia author non-byline.; Kuanprasert Srun author non-byline.; Yamwong Sukit author non-byline.; Johnston Nicola author non-byline.; Donnelly Patrick author non-byline.; Moriarty Andrew author non-byline.; Senior Roxy author non-byline.; Elghamaz Ahmed author non-byline.; Gurunathan Sothinathan author non-byline.; Karogiannis Nikolaos author non-byline.; Shah Benoy N. author non-byline.; Trimlett Richard H.J. author non-byline.; Rubens Michael B. author non-byline.; Nicol Edward D. author non-byline.; Mittal Tarun K. author non-byline.; Hampson Reinette author non-byline.; Gamma Reto author non-byline.; De Belder Mark author non-byline.; Nageh Thuraia author non-byline.; Lindsay Steven author non-byline.; Mavromatis Kreton author non-byline.; Miller Todd author non-byline.; Banerjee Subhash author non-byline.; Reynolds Harmony author non-byline.; Nour Khaled author non-byline.; Stone Peter author non-byline.;
• Is Part Of: Circulation. Volume 147:Issue 1(2022)
• Page Start: 8
• Page End: 19
• Publication Date: 2022-11-06
• Subjects: catheterization -- coronary artery bypass -- medication therapy management -- myocardial ischemia -- percutaneous coronary intervention; Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.122.062714
• Languages: English
• ISSNs: 0009-7322

Abstract

Abstract : 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% versus 4.4%; adjusted hazard ratio, 1.44 [95% CI, 1.08–1.91]) compared with the conservative strategy. No heterogeneity of treatment effect was evident in prespecified subgroups, including multivessel coronary disease. Conclusions: There was no difference in all-cause mortality with an initial invasive strategy compared with an initial conservative strategy, but there was lower risk of cardiovascular mortality and higher risk of noncardiovascular mortality with an initial invasive strategy during a median follow-up of 5.7 years. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04894877.