We are well aware of CAD physiopathological disparities and how it manifests differently in men and women. The ISCHEMIA study (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) has revealed that during 3.2 years no differences were seen in the incidence of ischemic events when comparing an invasive strategy (INV) vs a…
We Should Revascularize Patients with Stable Coronary Syndromes and Ischemia Assessed by iFR
Chronic stable angina has shown a good response to medical treatment, and the Ischemia study has recently demonstrated the safety of such treatment in stable chronic angina with moderate to severe ischemia. However, this study excluded left main coronary artery (LMCA) lesions. The FAME Study has shown the safety and efficacy of fractional flow reserve…
Post PCI Angina: Inevitable or Avoidable?
Predictors of post PCI angina Among the complications of ischemic cardiomyopathy stenting, those called chronic, with significant functional and mental compromise, might affect patient quality of life. This can be observed in different scenarios, such as instent restenosis and post PCI angina. This kind of complications is associated with anxiety and depression at long term. …
Patients with INOCA in the ISCHEMIA Trial
There has been an increase in the diagnosis of patients with proven ischemia who did not present obstructive coronary lesions (defined as the absence of stenosis ≥50%), called ischemia with non-obstructive coronary arteries (INOCA). These patients are at a higher risk for major adverse cardiac events (MACE) compared with the rest of the population. The…
ISCHEMIA: Prognosis is Determined by Anatomy, not Functionality
The ISCHEMIA study keeps providing scientific news. This work in patients with stable coronary artery disease had already shown (to our surprise) that ischemic burden does not predict 4-year mortality. Now, this new analysis suggests that anatomic severity can predict events. However (surprisingly, once more), altering this severity through angioplasty does not change the prognosis…
CT and Angiography Agreement in Patients from the ISCHEMIA Trial
Computed tomographic (CT) angiography showed a high degree of agreement with conventional angiography to detect significant coronary artery disease and rule out left main disease. This imaging study was done on a group of patients before their randomization in the ISCHEMIA trial. Data are soon to be published in JACC Cardiovascular Imaging and add plenty…
ISCHEMIA: New Analysis Might Change Study Outcome Interpretation
A new ISCHEMIA analysis has shown its outcomes are highly dependent on MI definition. The original conclusion had shown a significant difference between invasive and conservative strategies using the most sensible definition of MI: troponin elevation. When looking at events using MI definition as troponin elevation, we will see the conservative treatment reduces primary end…
High Risk Anatomy Challenges ISCHEMIA Outcomes
According to this recent analysis published in JAHA, patients with stable Ischemic heart disease and high-risk anatomy benefit from revascularization at long term vs. the conservative treatment. This goes against the study presented by Reynolds H et al at AHA 2020. Dr. Reynold’s was a sub-study of the ISCHEMIA trial which had observed that even…
ESC 2020 | Revascularization Strategies: Ventricular Dysfunction Might Tilt the Scales
Patients included in the ISCHEMIA trial who had a history of cardiac failure or ventricular function deterioration will benefit from revascularization vs. optimal medical treatment. This is a pre-specified analysis of the paradigmatic ISCHEMIA trial. The ISCHEMIA was published in March 2020 in NEJM and went somewhat unnoticed due to the COVID-19 pandemic. At the…