An NHLBI-funded trial found no evidence that some routine, invasive procedures, such as bypass surgery and stents, were better than drug therapy and lifestyle changes alone in preventing heart attacks and death. The researchers presented the findings on Nov. 16 at the American Heart Association’s Scientific Sessions 2019.
However, researchers did find that for patients overall with symptoms of angina – the chest pain caused by restricted blood flow to heart muscle – invasive treatments resulted in better symptom relief and quality of life that persisted for four years.
Dubbed ISCHEMIA, International Study of Comparative Health Effectiveness with Medical and Invasive Approaches, the trial randomly assigned 5,179 patients at 320 sites in 37 countries to receive one of the two treatment strategies, making it more than twice as large as any previous study of its kind.
An ancillary study, called ISCHEMIA-CKD, International Study of Comparative Health Effectiveness with Medical and Invasive Approaches - Chronic Kidney Disease (CKD), saw similar outcomes for CKD patients with significant but stable heart disease: No reduction in risk of death and heart attacks.
There was an important difference, however, invasive treatments did not result in better, long-term symptom relief and quality of life than among CKD patients who received only “optimal medical therapy” (OMT), the term for medications and lifestyle advice.