ISCHEMIA Trial: Was It Worth the Wait?

Rasha Al-Lamee, MBBS, MA, PhD; Alice K. Jacobs, MD


Circulation. 2020;142(5):517-519. 

In This Article

Ischemia Trial: What Have we Learned?

The results of ISCHEMIA provide new data in patients with SIHD and moderate to severe ischemia treated with contemporary GDMT and revascularization techniques. We have learned that an invasive strategy is not associated with a reduction in cardiovascular mortality or MI. In the invasive arm of the trial, there were more early MIs resulting from an excess of procedural MI, but this was offset by fewer spontaneous MIs during follow-up compared with the conservative strategy. The results emphasize the importance of GDMT in disease modification and symptom control and promote shared decision making and the importance of discussing early and late risks and benefits of each strategy. A delayed invasive strategy is safe, and coronary angiography may be avoided in the majority of patients, albeit with possible late hazard.