Ischemia Trial: Does the Cardiology Community Need to Pivot or Continue Current Practices?

Purpose of Review For decades, the standard of care for stable ischemic heart disease (SIHD) has been an ischemia-centric approach based on largely observational data suggesting a survival benefit of revascularization in patients with moderate-or-severe ischemia. In this article, we will objectively...

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Bibliographic Details
Published in:Current cardiology reports 2022-08, Vol.24 (8), p.1059-1068
Main Authors: Jafary, Fahim H., Jafary, Ali H.
Format: Article
Language:English
Subjects:
Angina Pectoris
Cardiology
Coronary Artery Disease - therapy
Humans
Medicine
Medicine & Public Health
Myocardial Infarction - therapy
Myocardial Ischemia - therapy
Public Health Policy (SS Virani and D Mahtta
Public Health Policy (SS Virani and D Mahtta, Section Editors)
Section Editors
Topical Collection on Public Health Policy
Treatment Outcome
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Summary:Purpose of Review For decades, the standard of care for stable ischemic heart disease (SIHD) has been an ischemia-centric approach based on largely observational data suggesting a survival benefit of revascularization in patients with moderate-or-severe ischemia. In this article, we will objectively review the evolution of the ischemia paradigm, the trial evidence comparing revascularization to medical therapy in SIHD, and what contemporary practice should be in 2022. Recent Findings Randomized trials, including COURAGE and, most recently, the ISCHEMIA trial, have shown no reduction in “hard outcomes” like death and myocardial infarction (MI) in SIHD compared to medical therapy. The trial excluded high-risk patients with left main disease, low ejection fraction (EF) 
ISSN:1523-3782
1534-3170
1534-3170
DOI:10.1007/s11886-022-01725-1