Initial Invasive or Conservative Strategy for Stable Coronary Disease

In the ISCHEMIA Trial, 5179 patients with moderate or severe myocardial ischemia were randomized equally into two groups based on initial management strategy: initial invasive strategy (angiography and revascularization when feasible) and medical therapy, or initial conservative strategy (medical therapy alone and angiography if medical therapy failed).  Primary endpoint was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest.  After a median follow-up of 3.2 years,  primary outcome events occurred in 318 of the invasive-strategy group and in 352 of the conservative-strategy group, the respective numbers of death were 145 and 144 in two groups. 

These results did not show that an initial invasive strategy of angiography and revascularization reduced the risk of ischemic cardiovascular events or all- cause death over a median of 3.2 years, as compared to an initial conservative strategy.