New study results found that guideline-directed medical treatment is as effective as invasive procedures, such as coronary stenting, at preventing heart attack, stroke, and death in patients with stable coronary artery disease (CAD).
Although the research supports a conservative approach to heart disease care, the study results also raise questions for people who are already receiving treatment for CAD, as well as those who have already had a surgical procedure to treat their condition. Here's what people need to know about the ISCHEMIA study results that were presented at the last American Heart Association Annual Meeting.
What is the ISCHEMIA study?
ISCHEMIA was a federally funded study that included 5,179 participants with ischemic heart disease. The purpose of the study was to determine the best management strategy for patients with higher-risk stable ischemic heart disease (SIHD). Ischemic heart disease is also called CAD or coronary heart disease (CHD). Researchers wanted to know whether these patients would benefit from invasive procedures, such as coronary angiography with stenting or coronary artery bypass surgery.
Coronary stenting is a minimally invasive surgical procedure where an interventional cardiologist restores normal blood flow to the heart by opening a blocked artery with a stent. Coronary artery bypass grafting (CABG) is an open surgery where a cardiac surgeon uses the patient's own arteries or veins to route blood around (bypass) blockages in the arteries supplying blood to the heart.
Who was included in the ISCHEMIA study?
All ISCHEMIA study participants were diagnosed with stable CAD using noninvasive testing methods such as a stress test, which shows how well your heart works during physical activity. CAD is considered to be stable when someone has not had a heart attack and does not have worsening symptoms -; such as angina (chest pain) or shortness of breath.
People who had unstable CAD, heart rhythm disorders, heart failure, advanced chronic kidney disease, and heart valve disease -; as well as people who had a heart attack or invasive surgical procedure -; were not included in the study.
Does the ISCHEMIA study say that medication is better than surgery for people with CAD?
It is important to understand that the ISCHEMIA study results suggested equal effectiveness in preventing three events -; heart attack, stroke, and death -; in people who have stable CAD. The study did not suggest that medication is better than invasive procedures, or that invasive procedures were worse than medication. Also, the ISCHEMIA study results only apply to patients with stable CAD. The results do not apply to people who have heart failure, a history of heart attack, symptoms that are increasing in severity, or other more life-threatening cardiac conditions.
Are there some situations when surgery may be more beneficial for CAD?
Coronary stents and other surgical interventions, which are types of revascularization, may provide better symptom relief than medications for people with stable CAD who have chest pain and shortness of breath. Generally, the more chest pain a patient has, the more likely they are to benefit from revascularization. In fact, 23 percent of ISCHEMIA study participants who were initially treated with only medication therapy ended up having a surgical procedure to treat lingering symptoms. Related Stories
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