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ISCHEMIA
About the Trial
The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches randomized 5,179 patients with moderate or severe ischemia to routine invasive angiography and revascularization or optimal medical therapy. Over a median of 3.2 years, the invasive strategy did not reduce the primary composite of cardiovascular death, heart attack, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest, though it improved symptoms and reduced spontaneous heart attacks after the periprocedural bump. ISCHEMIA, with COURAGE, strengthened the case for medical therapy as the initial approach in many stable patients, with revascularization mainly for symptoms or high risk anatomy. The trial exemplified evidence overturning procedural incentives in modern cardiology.
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