This review surveys the findings of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial and puts them into a clinical perspective regarding its effect of the role of cardiac magnetic resonance imaging (CMR) as a well-validated gatekeeper for invasive angiography and myocardial revascularization. Noninvasive stress testing of patients with intermediate-to-high pretest likelihood for obstructive coronary artery disease (CAD) using perfusion CMR provides excellent diagnostic accuracy in detecting ischemic myocardium, and additional information from tissue characterization can guide the management of patients with stable angina toward a more individualized therapy as other non-coronary underlying causes of chest pain can be detected. Since ISCHEMIA failed to show that an invasive strategy using percutaneous coronary intervention or coronary artery bypass grafting was associated with an improved prognosis compared with initial conservative medical therapy among stable patients with moderate-to-severe ischemia, CMR as a multifaceted diagnostic imaging approach to explain patients’ symptoms should be preferred over anatomical and stress testing alone. Nevertheless, the exclusion of left main coronary artery stenosis either by coronary CT or MR angiography may be required. In conclusion, the results of the ISCHEMIA trial are in good accordance with those of the MR-INFORM trial recently published in the New England Journal of Medicine, as the noninvasive management of a large proportion of patients with CAD was shown to be noninferior to current invasive strategies. Recent outcome data from trials may therefore have an impact on future guidelines to further reduce the execution of unnecessary left heart catheterizations.

这篇综述调查了国际医学和侵入性方法比较健康效果研究（ISCHEMIA）的研究结果，并将其纳入临床研究，探讨了其对心脏磁共振成像（CMR）作为公认的门卫的作用的作用。有创血管造影和心肌血运重建。使用灌注CMR对患有阻塞性冠状动脉疾病（CAD）的中至高预测试可能性患者进行无创压力测试，在检测缺血性心肌方面可提供出色的诊断准确性，并且组织表征的其他信息可指导稳定型心绞痛患者的治疗由于可以检测到其他非冠状动脉性胸痛的潜在原因，因此可以进行更多的个体化治疗。由于ISCHEMIA未能显示出在稳定至中度至重度缺血的稳定患者中，采用经皮冠状动脉介入治疗或冠状动脉搭桥术的侵入性策略与初始保守药物治疗相比可改善预后，因此将CMR作为多方面的诊断成像方法来进行解释患者的症状应优于单独的解剖学和压力测试。然而，可能需要通过冠脉CT或MR血管造影排除左主冠状动脉狭窄。总之，ISCHEMIA试验的结果与最近发表在《美国医学杂志》上的MR-INFORM试验的结果相符。CMR作为解释患者症状的多方面诊断成像方法，应优于单独进行解剖和压力测试。然而，可能需要通过冠脉CT或MR血管造影排除左主冠状动脉狭窄。总之，ISCHEMIA试验的结果与最近发表在《美国医学杂志》上的MR-INFORM试验的结果相符。CMR作为解释患者症状的多方面诊断成像方法，应优于单独进行解剖和压力测试。然而，可能需要通过冠脉CT或MR血管造影排除左主冠状动脉狭窄。总之，ISCHEMIA试验的结果与最近发表在《美国医学杂志》上的MR-INFORM试验的结果相符。新英格兰医学杂志（New England Journal of Medicine）指出，由于大部分CAD患者的无创治疗均不逊色于当前的侵入性策略。因此，来自试验的最新结果数据可能会对将来的指南产生影响，以进一步减少不必要的左心导管插入术的执行。