ISCHEMIA
International Study of Comparative Health Effectiveness with Medical and Invasive Approaches
Paciente / Población Intervención / Exposición Comparación Desenlace
In 5,179 patients with stable CAD and moderate-to-severe ischaemia, an initial invasive strategy did not reduce CV death, MI, hospitalisation for unstable angina, HF or resuscitated arrest compared with an initial conservative strategy.
N
5179
Diseño
RCT, median 3.2 yr
Desenlace
CV death, MI, hosp for UA/HF, resus arrest
Relevancia
1
Resultado13.3 % vs 15.5 % (HR 0.93, ns). Better angina QoL with invasive strategy.
Maron DJ, et al. N Engl J Med. 2020;382(15):1395-1407. 10.1056/NEJMoa1915922
Discusión y crítica
Excluded left main, EF < 35 %, recent ACS. Event curves cross at ~ 2 yr — early harm, late benefit. Does not apply to ACS or left-main disease.