Trending Clinical Topic: ISCHEMIA Trial

Ryan Syrek

Disclosures

November 29, 2019

Each week, we identify one top search term, speculate as to what caused its popularity, and provide an infographic on a related condition. If you have thoughts about what's trending and why, feel free to share them with us on Twitter or Facebook.

Trending Clinical Topic: ISCHEMIA Trial

Each week, we identify one top search term, speculate as to what caused its popularity, and provide an infographic on a related condition. If you have thoughts about what's trending and why, feel free to share them with us on Twitter or Facebook.

Thanks to findings that may fundamentally change the practice of cardiology, the ISCHEMIA trial is this week's top trending clinical topic. Results of the much anticipated study were announced at the American Heart Association (AHA) Scientific Sessions 2019. The ISCHEMIA trial failed to show that early invasive treatment strategies that included revascularization resulted in fewer major cardiovascular events than optimal medical therapy in patients with stable ischemic heart disease. The study included nearly 5200 patients with significant stable coronary artery disease (CAD) and found that invasive and conservative strategies had similar outcomes over a median of 3.3 years of follow-up.

The results of the ISCHEMIA trial challenge the frequently held belief that offering revascularization in this patient population is more protective against heart attack or death, especially in high-risk patients. Instead, as other experts who have reacted to the study have pointed out, the findings show that interventions such as lifestyle modifications, common cardiac medications, and smoking cessation can be equally effective. John Spertus, MD, who reported on the ISCHEMIA trial at the AHA session, stated in an interview, "The take-home message for me as a practicing cardiologist is that I don't have to feel that I am doing any harm by trying medicines first to see if it can control their symptoms—even in the highest-risk patients with myocardial ischemia."

Responding to the ISCHEMIA trial results, John Mandrola, MD, spoke about the next steps for clinicians. "That blockage is not a time bomb in your chest. The clear results of ISCHEMIA, combined with the prior evidence, show that the clogged-pipe frame of treating (stable) CAD was wrong. Clinicians must help change the public perception." Considering that heart disease accounts for 1 in every 4 deaths in the United States and is the leading cause of death worldwide, it is not surprising that the ISCHEMIA trial is this week's top trending clinical topic.

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