Complete Revascularization and Angina-Related Health Status in the ISCHEMIA Trial

• Published in: Journal of the American College of Cardiology 2023-07, Vol.82 (4), p.295-313
• Main Authors: Mavromatis, Kreton, Jones, Philip G., Ali, Ziad A., Stone, Gregg W., Rhodes, Grace M., Bangalore, Sripal, O’Brien, Sean, Genereux, Philippe, Horst, Jennifer, Dressler, Ovidiu, Goodman, Shaun, Alexander, Karen, Mathew, Anoop, Chen, Jiyan, Bhargava, Balram, Uxa, Amar, Boden, William E., Mark, Daniel B., Reynolds, Harmony R., Maron, David J., Hochman, Judith S., Spertus, John A.
• Format: Article
• Language: English
• Subjects: Angina Pectoris - epidemiology; Angina Pectoris - surgery; complete revascularization; Coronary Artery Disease; Health Status; Humans; Ischemia; Myocardial Revascularization; Quality of Life; revascularization; Treatment Outcome
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2023.05.025

The impact of complete revascularization (CR) on angina-related health status (symptoms, function, quality of life) in chronic coronary disease (CCD) has not been well studied. Among patients with CCD randomized to invasive (INV) vs conservative (CON) management in ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), we compared the following: 1) the impact of anatomic and functional CR on health status compared with incomplete revascularization (ICR); and 2) the predicted impact of achieving CR in all INV patients compared with CON. Multivariable regression adjusting for patient characteristics was used to compare 12-month health status after independent core laboratory-defined CR vs ICR in INV patients who underwent revascularization. Propensity-weighted modeling was then performed to estimate the treatment effect had CR or ICR been achieved in all INV patients, compared with CON. Anatomic and functional CR were achieved in 43.3% and 57.8% of 1,641 INV patients, respectively. Among revascularized patients, CR was associated with improved Seattle Angina Questionnaire Angina Frequency compared with ICR after adjustment for baseline differences. After modeling CR and ICR in all INV patients, patients with CR and ICR each had greater improvements in health status than CON, with better health status with CR than ICR. The projected benefits of CR were most pronounced in patients with baseline daily/weekly angina and not seen in those with no angina. Among patients with CCD in ISCHEMIA, health status improved more with CR compared with ICR or CON, particularly in those with frequent angina. Anatomic and functional CR provided comparable improvements in quality of life. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522) [Display omitted]