11/16/2019 | Press release | Distributed by Public on 11/16/2019 17:44
Contribution To Literature:
The ISCHEMIA-CKD trial failed to show that routine invasive therapy was associated with a reduction in death/myocardial infarction vs. medical therapy among stable patients with moderate ischemia and chronic kidney disease.
The goal of the trial was to evaluate routine invasive therapy compared with optimal medical therapy among patients with stable ischemic heart disease, moderate to severe myocardial ischemia on noninvasive stress testing, and advanced chronic kidney disease.
Patients with stable ischemic heart disease, moderate to severe ischemia, and chronic kidney disease were randomized to routine invasive therapy (n = 388) versus medical therapy (n = 389).
In the routine invasive therapy group, subjects underwent coronary angiography and percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) as appropriate.
In the medical therapy groups, subjects underwent coronary angiography only for failure of medical therapy.
Angina frequency at baseline:
Other salient features/characteristics:
The primary outcome, death or myocardial infarction at 2.3 years, occurred in 36.4% of the routine invasive group compared with 36.7% of the medical therapy group (p = 0.95).
Quality of life outcomes: Improvement in symptoms was observed among those with daily/weekly/monthly angina, but not in those without angina.
Among patients with stable ischemic heart disease, moderate to severe ischemia on noninvasive stress testing, and advanced chronic kidney disease, routine invasive therapy failed to reduce the incidence of death or myocardial infarction compared with optimal medical therapy. There was also no benefit from invasive therapy regarding all-cause mortality. There was a large proportion of subjects with no angina at baseline. Routine invasive therapy failed to improve angina symptoms and quality of life compared with medical therapy. These results do not apply to patients with current/recent acute coronary syndrome, highly symptomatic patients, or left ventricular ejection fraction <35%. Overall, mortality was high and not impacted (positively or negatively) by routine invasive therapy.
Presented by Sripal Bangalore at the American Heart Association Annual Scientific Sessions (AHA 2019), Philadelphia, PA, November 16, 2019.
Presented by John A. Spertus at the American Heart Association Annual Scientific Sessions (AHA 2019), Philadelphia, PA, November 16, 2019 (quality of life outcomes).
Clinical Topics:Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and SIHD, Acute Heart Failure, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Magnetic Resonance Imaging, Nuclear Imaging
Keywords:AHA Annual Scientific Sessions, AHA19, Acute Coronary Syndrome, Angina Pectoris, Angina, Unstable, Cardiac Catheterization, Coronary Angiography, Coronary Artery Bypass, Coronary Artery Disease, Exercise Test, Heart Arrest, Heart Failure, Kidney Diseases, Magnetic Resonance Imaging, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Renal Dialysis, Renal Insufficiency, Chronic, Secondary Prevention, Stroke, Stroke Volume