Virtual ACC 2020 | ISCHEMIA-CKD: Invasive Strategy vs. Medical Treatment in Higher Risk Patients

This pre-specified protocol originally included 777 patients with chronic kidney failure. These patients are a special population of higher risk where we might be able to see the advantage of a more aggressive initial strategy.

Death or MI rate (combined primary end point) resulted 36.4% for the invasive strategy vs. 36.7% for the initially conservative strategy with optimal medical treatment (HR 1.01; CI 95% 0.79-1.29). 

Secondary end points such as death rate considered separately, non-fatal MI, hospitalization due to unstable angina, cardiac failure or cardiac arrest also resulted practically identical with 38.5% vs 39.7%, respectively (HR 1.01; CI 95% 0.79 to 1.29).

Stroke rate increased with the invasive strategy (HR 3.76; 95% CI 1.52-9.32) as well as risk of dialysis HR (1.48; CI 95% 1.04-2.11).

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

And it this weren’t enough, patients with chronic kidney failure didn’t even show symptom improvement after revascularization. 

Original Title: Management of coronary disease in patients with advanced kidney disease.

Reference: Bangalore S et al. N Engl J Med. 2020; Epub ahead of print y presentado en forma virtual en el ACC 2020.

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