AHA 2019 | ISCHEMIA-CKD: Chronic Kidney Disease and Stable Coronary Disease

Among patients in the main ISCHEMIA trial, those with chronic kidney disease are a particularly high-risk subgroup. However, an invasive strategy with coronary angiography and revascularization did not improve the rate of events, similarly to what happened in the general population for the aforementioned trial.

The rate of death or acute myocardial infarction was 36.4% with the invasive approach and 36.7% with optimal medical therapy alone (hazard ratio [HR]: 1.01; 95% confidence interval [CI]: 0.79-1.29) according to a presentation by Dr. Bangalore during the American Heart Association (AHA) 2019 Scientific Sessions.

The lack of benefit with the invasive strategy was also seen in other, softer, endpoints and, in fact, there was an increase in the risk for stroke compared with medical treatment alone. The composite safety endpoint (death or new dialysis) was more frequent in the invasive arm (HR: 1.48; 95% CI: 1.04-2.11).

Invasive treatment also failed the quality-of-life analysis for the population with chronic kidney disease, unlike the general population in the main ISCHEMIA trial, who experienced at least a symptomatic benefit.


Read also: AHA 2019 | ISCHEMIA: The Invasive Approach (PCI or Surgery) Results Similar to Optimal Medical Treatment.


These results for the chronic kidney disease population are somewhat surprising, since researchers expected to see a more risk = more benefit scenario with an invasive strategy.

A possible explanation for the lack of symptom relief could be the low rate of angina, about 12% of patients, in this population at the time of randomization.

The ISCHEMIA-CKD trial was conducted in 30 countries and included 777 patients with glomerular filtration rate less than 30 mL/min/1.73 m2 or on dialysis, stable coronary disease, and at least moderate ischemia. Over half (53%) the patients were on dialysis.

Patients were randomized to a routine invasive strategy (coronary angiography and revascularization) plus optimal medical treatment or to optimal medical treatment alone (patients in this arm were revascularized if their symptoms worsened or in case of emergency).


Read also: Temporal Trends and Outcomes of TAVR in Bicuspids: Are We Any Better?


After a follow-up of over 2 years, the rate of death or infarction was similar for both arms.

Original Title: International study of comparative health effectiveness with medical and invasive approaches–chronic kidney disease (ISCHEMIA-CKD): primary results of clinical outcomes.

Reference: Bangalore S. Presentado en el AHA 2019. Noviembre 16, 2019. Philadelphia, PA.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....