Cardiology ·
ISCHEMIA-EXTEND Finds No Long-Term Survival Advantage for Early Procedures
In an extended follow-up of the randomized ISCHEMIA trial, early invasive treatment for stable coronary artery disease was not associated with better survival than initial medical therapy. After nearly a decade, reported death rates were 26% and 27%, respectively; early procedures had previously been shown to ease symptoms and improve quality of life.
- Long-term death rates were similar between treatment strategies.
- Early procedures can relieve symptoms and improve quality of life.
- Findings apply to stable coronary disease, not acute heart attacks.
- Extended follow-up did not assess several nonfatal outcomes.
ISCHEMIA-EXTEND followed participants from the international ISCHEMIA trial, which enrolled more than 5,000 people with stable coronary artery disease and abnormal stress tests across 320 hospitals in 37 countries. Participants had initially been assigned to an invasive strategy—early coronary procedures alongside medication and lifestyle measures—or a conservative strategy, with procedures reserved for worsening symptoms or events. The extended analysis assessed long-term survival using direct contact and national health records.
After nearly a decade, the reported chance of death was 26% in the invasive-strategy group and 27% in the conservative-strategy group. The investigators recorded 1,071 deaths through as long as 13 years after enrollment and confirmed vital status for 96% of participants. The release says the earlier trial found symptom and quality-of-life benefits from early procedures, but no reduction in serious heart problems.
The findings concern stable coronary disease and should not be applied to heart attacks or threatened heart attacks, for which the release describes procedures as lifesaving. The analysis did not track nonfatal heart attacks, repeat procedures, or quality of life beyond the initial trial period. The results were reported in a university press release as being presented at the American Heart Association Scientific Sessions and published in JAMA; funding came from a U.S. National Institutes of Health grant.
In practice
For people with stable coronary artery disease similar to the ISCHEMIA participants, the extended follow-up found no apparent long-term survival advantage from an initial invasive strategy over medical therapy with procedures reserved for clinical need. The release reports death rates of 26% versus 27% after nearly a decade. Early procedures may still relieve chest pain and improve quality of life. These results do not apply to acute or threatened heart attacks, and the analysis did not assess several outcomes, including nonfatal heart attacks and later quality of life.
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PR Newswire – Health: Routine Invasive Procedures for Stable Heart Disease Offer No Long-Term Survival Advantage Over Drug Therapy ↗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.