Lessons Learned from the ISCHEMIA Trial

A recent trial by the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) addressed the idea of treating ischemia with invasive approaches to improve outcomes. They investigated whether this would prove more beneficial than non-invasive approaches, such as pharmacological treatments or lifestyle changes. It was found that initially, pharmacological agents (such as ranolazine or ivabradine), anti-anginal therapy (such as beta-blockers or nitrates) and lifestyle changes should be the front-line approaches. This is because after a 3.2-year follow up on the patients involved, no evidence was found that revascularisation reduced the chances of primary nor secondary events.

This review by Boden WE & Stone PH aimed to contribute to a very vigorous debate within the cardiovascular community, discussing the evidence for and against medical therapy and revascularisation in patients.

Key learnings:

This study concluded that an invasive approach is preferred only if symptoms and quality life worsen during pharmacological or lifestyle intervention treatments. This highlights the importance of tailoring individual treatment and management to patients, to ensure their outcomes are the best possible for their individual condition.