Clinical Implications of the ISCHEMIA Trial: Invasive vs Conservative Approach in Stable Coronary Disease.

PURPOSE OF REVIEW: To identify key strengths and weaknesses of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial and explore its clinical implications in patients with stable ischemic heart disease.

RECENT FINDINGS: Previous studies have shown inconsistent benefit of early angiography and revascularization in patients with stable ischemic heart disease. The ISCHEMIA trial showed no significant reduction in mortality or cardiovascular outcomes in patients undergoing early angiography and revascularization with guideline-directed medical therapy compared to patients on medical therapy alone in specific patient population with stable coronary artery disease. The ISCHEMIA trial provides insights into invasive versus pharmacological treatment for patients with stable ischemic heart disease. Though it may have reduced applicability given its broad exclusion criteria, it offers useful information about the utility of non-invasive imaging modalities for selecting optimal revascularization candidates.