The ISCHEMIA trial is a large, multicentric trial sponsored by the National Heart, Lung, and Blood Institute. The main trial compared coronary revascularization and optimal medical therapy (OMT) vs OMT alone in 5179 patients enrolled after a stress test. It is considered the largest comparative effectiveness trial of an invasive vs conservative strategy in patients with stable coronary disease.
An important component needs to be answered in order to help clinicians manage their patients: what are the implications for clinical practice? Take-home message: The ISCHEMIA trial “deeply disrupted many of our prior attitudes regarding management strategies for patients with stable coronary artery disease.” The findings underscore the benefits of disease-modifying OMT for stable coronary artery disease patients. These results might challenge the current diagnostic approach for stable angina patients recommended in the last European Society of Cardiology guidelines on chronic coronary disease that were based on studies published before the ISCHEMIA trial