In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. The primary analysis showed no significant difference in the risk of death or myocardial infarction with invasive strategy as compared with conservative strategy, in participants with stable ischaemic heart disease, moderate or severe ischaemia, and advanced chronic kidney disease.
The authors assessed angina-related health status in these patients. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group favoured the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline and nearly absent among those without angina at baseline. By 6 months, the between-group difference in the overall trial population was attenuated. Take-home message: participants did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy.