Stents and surgery no better than less invasive measures at reducing heart attack for stable ischemic heart disease

Invasive procedures, such as bypass surgery and stenting, are no better than medication, diet and exercise at reducing the risk of heart attack and death in people with severe, but stable ischemic heart disease. But those invasive procedures can provide symptom relief and improve quality of life for people suffering daily or weekly chest pain from angina.

The final results of from the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA), published in The New England Journal of Medicine on March 30, 2020, had also garnered much attention when researchers presented preliminary results in fall 2019. It is anticipated that these findings could influence clinical practice for this specific patient population.

Funded by NHLBI, ISCHEMIA randomly assigned 5,179 patients around the world to receive either medical therapy and lifestyle changes based on clinical guidelines (unless symptoms got worse) or medical therapy and invasive intervention soon after having an abnormal stress test.

Two other companion studies published in The New England Journal of Medicine—ISCHEMIA-chronic kidney disease (CKD) and quality of life study—showed that similar invasive procedures compared to medical therapy did not reduce the risk of death and heart attack for participants with advanced CKD and severe, stable coronary disease. There were no benefits in quality of life even among participants with angina.

Read the Papers

Initial Invasive or Conservative Strategy for Stable Coronary Disease

Health-Status Outcomes with Invasive or Conservative Care in Coronary Disease

Management of Coronary Disease in Patients with Advanced Kidney Disease

Health Status after Invasive or Conservative Care in Coronary and Advanced Kidney Disease

Editorial: Managing Stable Ischemic Heart Disease