The finding
Patients with stable heart disease and abnormal stress tests who had invasive procedures early in their care did not live longer than those treated first with drugs and lifestyle changes alone, the researchers said. After nearly a decade, the early-procedure group had a 26% chance of death and the conservative group 27%, according to the follow-up study, called ISCHEMIA-EXTEND. It recorded 1,071 deaths up to 13 years after patients entered the study and established the vital status of 96% of participants. The work builds on an earlier ISCHEMIA trial of more than 5,000 men and women with stable coronary artery disease.
How the study was run
The researchers assessed patients at 320 hospitals in 37 countries in Europe, North America, Asia and the South Pacific. All received drugs for cholesterol and blood pressure management, plus dietary and exercise counseling. One group had heart procedures soon after an abnormal stress test; the other received such care only if symptoms worsened or a heart attack occurred. The results will be presented on Nov. 7 at the American Heart Association's annual Scientific Sessions and published online at the same time in the Journal of the American Medical Association.
What the researchers say
Judith S. Hochman, the study's co-lead author and ISCHEMIA chair, said early procedures can relieve chest pain and improve quality of life for patients with chest pain but are unlikely to help them live longer. Rebecca Anthopolos, the study's other co-lead author, said patients and providers need thoughtful discussions about goals and trade-offs; early procedures relieve symptoms but carry risks and should be weighed against evidence that modern medicines and healthy habits lead to similar survival. Hochman said the findings apply to stable patients with chronic coronary disease, while procedures to open narrowed arteries are lifesaving for patients with heart attacks and threatened heart attacks. Anthopolos cautioned that the analysis did not track nonfatal heart attacks, repeat procedures or quality of life beyond the initial trial period.
