Cardiology · Nephrology ·
ISCHEMIA-CKD Extension Finds No Long-Term Mortality Benefit From Initial Invasive Strategy
In extended follow-up of the randomized ISCHEMIA-CKD trial, 777 patients with advanced chronic kidney disease and at least moderate ischemia were followed for a median of 8 years. All-cause and cardiovascular mortality did not differ significantly between initial invasive and conservative management strategies.
- Trial extension followed 777 participants for a median of 8 years.
- All-cause mortality was 57.4% with invasive management and 56.8% with conservative management.
- Cardiovascular mortality did not differ significantly between strategies.
- The reported findings concern mortality outcomes.
The ISCHEMIA-CKD trial randomized 777 patients with advanced chronic kidney disease and at least moderate myocardial ischemia to an initial invasive strategy—coronary angiography and revascularization when feasible, plus guideline-directed medical therapy—or an initial conservative strategy of medical therapy, with invasive procedures reserved for treatment failure. This extension assessed long-term vital status; the primary outcome was all-cause mortality, with cause-specific mortality as a secondary outcome.
Over a median 8 years, 429 participants (55%) died. Cumulative all-cause mortality was 57.4% with the invasive strategy and 56.8% with the conservative strategy (adjusted hazard ratio, 1.05; 95% CI, 0.87–1.28). Cardiovascular mortality was 40.3% and 38.4%, respectively (adjusted hazard ratio, 1.06; 95% CI, 0.84–1.34). Neither difference was statistically significant. Vital status was available for 95% of survivors.
The findings show no significant long-term mortality benefit from an initial invasive approach in this population. They extend follow-up of a randomized trial, but the reported outcomes address mortality and do not establish comparative effects on other outcomes, such as symptoms. The study was registered as NCT01985360.
In practice
For patients with advanced chronic kidney disease and at least moderate ischemia, this randomized-trial extension found no significant difference in all-cause or cardiovascular mortality over a median of 8 years between initial invasive and conservative strategies. These results do not support an expectation of long-term mortality benefit from choosing an initial invasive strategy in this population. The reported comparison is limited to mortality outcomes; it does not establish effects on symptoms or other clinical outcomes, and should not be interpreted as evidence about patients outside the studied population.
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Circulation: Long-Term Survival After Initial Invasive or Conservative Management of Stable Coronary Disease in Patients With Advanced Chronic Kidney Disease: ISCHEMIA-CKD EXTEND ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.