An international randomized trial revealed that an initial invasive approach compared to optimal medical therapy (OMT) in stable ischemic heart disease (SIHD) patients with moderate-severe ischemia did not reduce risk of cardiovascular disease (CVD) end points at a median of 3.3 years. The trial enrolled 5179 SIHD patients with moderate-severe ischemia in 37 countries, median age 64 years old. The curves cross for the primary endpoint (CV death, non-fatal myocardial infarction [MI], resuscitated cardiac arrest, hospitalization for unstable angina, or heart failure) and the major secondary endpoint (CV death, MI) at approximately 2 years from randomization, with an absolute 1.9% more events in the first 6 months and 2.2% fewer at 4 years compared with OMT. Procedural MIs were increased (early risk) while spontaneous MIs were reduced (later benefit) with an invasive strategy. Similar findings were also revealed in a trial of 777 patients with advanced chronic kidney disease and moderate or severe ischemia. The results are consistent with previous studies. Source: https://www.medpagetoday.com/
