title: Conservative versus invasive stable ischemic heart disease management strategies: what do we plan to learn from the ISCHEMIA trial?
abstract: Over the past decade, landmark randomized clinical trials comparing initial management strategies in stable ischemic heart disease (SIHD) have demonstrated no significant reduction in 'hard' end points (all-cause mortality, cardiac death or myocardial infarction) with one strategy versus another. The main advantage derived from early revascularization is improved short-term quality of life. Nonetheless, questions remain regarding how best to manage SIHD patients, such as whether a high-risk subgroup can be identified that may experience a survival or myocardial infarction benefit from early revascularization, and if not, when should diagnostic catheterization and revascularization be performed. The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial is designed to address these questions by randomizing SIHD patients with at least moderate ischemia to an initial conservative strategy of optimal medical therapy or an initial invasive strategy of optimal medical therapy plus cardiac catheterization and revascularization.
authors.affiliation: Division of Cardiology, Department of Medicine, Albany Medical Center, NY 10021, USA.|Albany Stratton VA Medical Center, 113 Holland Avenue, Albany, NY 12208, USA.|Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Cheng-Torres
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine & Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
authors.forename: Karan P
authors.initials: KP
authors.lastname: Desai
authors.affiliation: Division of Cardiology, Department of Medicine, Albany Medical Center, NY 10021, USA.|Albany Stratton VA Medical Center, 113 Holland Avenue, Albany, NY 12208, USA.|Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sidhu
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.affiliation: Division of Cardiology, Department of Medicine, Albany Medical Center, NY 10021, USA.|Albany Stratton VA Medical Center, 113 Holland Avenue, Albany, NY 12208, USA.|Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
mesh_terms: D006328:Cardiac Catheterization; D002317:Cardiovascular Agents / Q000627:therapeutic use; D006801:Humans; D017202:Myocardial Ischemia / Q000628:therapy*; D009204:Myocardial Revascularization; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic
chemical_list: D002317:Cardiovascular Agents
keywords: coronary anatomy; coronary artery disease; myocardial ischemia; optimal medical therapy; revascularization; stable ischemic heart disease