The long-term follow-up of patients will be needed to better determine the true difference in prognosis between these two groups.
For patients with angina, or chest pain, the comparative benefits of an invasive procedure over medical therapy alone were more consistent throughout the trial.
"ISCHEMIA showed an impressive, sustainable improvement in patients' symptoms, function and quality of life with an invasive strategy for up to four years of follow-up," said John Spertus, M.D., M.P.H., director of health outcomes research at Saint Luke's Mid America Heart Institute in Kansas City, MO., and co-principal investigator for the ISCHEMIA quality of life analysis. "However, this benefit was only observed in roughly two-thirds of those who had angina at baseline and no benefit was seen in those who had no symptoms."
"Taken together, the quality of life and clinical results suggest that there is no need for invasive procedures in patients without symptoms," said David Maron, M.D., director of the Stanford Prevention Research Center at Stanford University and the study's lead author and principal investigator. "For those with angina, our results show it is just as safe to begin treating with medication and lifestyle change, and then if symptoms persist, discuss invasive treatment options."
Two other ISCHEMIA companion studies produced other key results. ISCHEMIA-Chronic Kidney Disease (CKD) and quality of life studies, also published in the New England Journal of Medicine, did not show a reduced risk for death and heart attack for participants who had advanced chronic kidney disease, stable coronary disease, as well as moderate or severe ischemia with the invasive treatment compared to the conservative treatment. There were no benefits in quality of life, even if participants had angina symptoms.
About the National Heart, Lung, and Blood Institute (NHLBI):
NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives.
About the National Institutes of Health (NIH):
NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.
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