In the general study, an invasive strategy followed by revascularization (when necessary) vs. an initially conservative strategy with OMT resulted similar in patients with stable CAD with moderate to severe ischemia. A secondary end point of this analysis were angina symptoms and quality of life.

Angina symptoms, functional activity and quality of life were assessed with the Seatle Angina Questionaire (SAQ) at randomization, 45 days, 6 months and every 6 months thereafter. Data were obtained on the 2295 patients randomized to the invasive strategy and on 2322 from the conservative strategy. The SAQ scores from 0 to 100 points where 100 is the healthiest.

At baseline, 35% of patients did not report any angina symptoms in the last month. The SAQ score improved with both strategies, especially at early follow-up, and levelled off later on. This improvement resulted superior with the invasive strategy, even for the general population, that included more than one third of patients with no angina (which could cancel out the difference).

Read also: Virtual ACC 2020 | Controversial Trial ISCHEMIA Finally in NEJM.

If we consider the most symptomatic (daily angina or at least once a month) vs. patients with no angina, the difference in favor of the invasive strategy becomes more marked. 

Conclusion

Patients randomized to an invasive strategy with eventual randomization showed symptom improvement superior vs. OMT. This significant difference, though modest in the general population (35% asymptomatic at randomization), increases the more symptomatic the patients are at baseline. 

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Original Title: Health-Status Outcomes with Invasive or Conservative Care in Coronary Disease.

Reference: John A. Spertus et al. N Engl J Med 2020, article in press. 

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