Initial Invasive or Conservative Strategy for Stable Coronary Disease.

@article{Maron2020InitialIO,
  title={Initial Invasive or Conservative Strategy for Stable Coronary Disease.},
  author={D. Maron and J. Hochman and H. Reynolds and S. Bangalore and S. O'Brien and W. Boden and B. Chaitman and R. Senior and J. L{\'o}pez-Send{\'o}n and K. Alexander and R. Lopes and L. Shaw and J. Berger and J. Newman and M. Sidhu and S. Goodman and W. Rużyłło and G. Gosselin and A. Maggioni and H. White and B. Bhargava and J. Min and G. Mancini and D. Berman and M. Picard and R. Kwong and Z. Ali and D. Mark and J. Spertus and M. Krishnan and A. Elghamaz and N. Moorthy and W. Hueb and M. Demkow and K. Mavromatis and O. Bockeria and J. Peteiro and Todd D. Miller and H. Szwed and R. Doerr and M. Keltai and J. Selvanayagam and P. Steg and C. Held and S. Kohsaka and Stavroula Mavromichalis and R. Kirby and Neal O. Jeffries and F. Harrell and F. Rockhold and Samuel H Broderick and T. Ferguson and D. Williams and R. Harrington and G. Stone and Y. Rosenberg},
  journal={The New England journal of medicine},
  year={2020}
}
BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone… Expand

Paper Mentions

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Management of Coronary Disease in Patients with Advanced Kidney Disease.
TLDR
Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, it was found that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction. Expand
Implications of the Landmark ISCHEMIA Trial on the Initial Management of High-Risk Patients with Stable Ischemic Heart Disease
In the decades following the advent of percutaneous coronary intervention, the optimal treatment strategy for managing stable ischemic heart disease has remained a topic of debate. The purpose ofExpand
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TLDR
In patients with stable ischemic heart disease, routine revascularization was not associated with improved survival but was associated with a lower risk of nonprocedural MI and unstable angina with greater freedom from angina at the expense of higher rates of procedural MI. Expand
ISCHEMIA trial: Is there enough evidence to drive a change in clinical practice? A critical appraisal.
TLDR
It is premature to change clinical practice in view of the results of ISCHEMIA trial, as stable CAD patients is a vastly heterogenous patient group and it may be prudent to apply common clinical judgement and individual decision-making according to current guidelines before changing management strategies. Expand
Health-Status Outcomes with Invasive or Conservative Care in Coronary Disease.
TLDR
In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to a conservative strategy. Expand
Health Status after Invasive or Conservative Care in Coronary and Advanced Kidney Disease.
BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plusExpand
Medical Therapy Versus Revascularization in Patients with Stable Ischemic Heart Disease and Advanced Chronic Kidney Disease
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An initial revascularization strategy does not reduce mortality or MI or relieve angina symptoms in patients with stable ischemic heart disease and advanced chronic kidney disease. Expand
ISCHEMIA trial: Back to the future or forward to the past?
TLDR
The main finding was that, among stable patients who had evidence of moderate to severe ischemia on stress testing, an initial invasive strategy, when compared with an initial conservative strategy, was not associated with a reduction in the primary outcome of cardiovascular death, myocardial infarction, or resuscitated cardiac arrest over a median follow-up of 3.3 years. Expand
The year in review: advances in interventional cardiology in 2019.
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Major studies in interventional cardiology in 2019 have added substantial new evidence for pharmaco-invasive management of coronary artery disease and intravascular imaging guidance improves post-PCI outcomes, warranting increased use in clinical practice. Expand
Application and clinical implications of revascularization on chronic coronary syndromes: From COURAGE to ISCHEMIA trial.
TLDR
There are cases of patients suffering from refractory angina or with significant burden of ischemia in non-invasive testing that have not been included in the trial, where invasive approach may have a role in improving quality of life or even in decreasing the risk of a coronary event. Expand
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