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Clinical Implications and Debates on the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches Trial
Cardiology in Review ( IF 2.1 ) Pub Date : 2022-09-01 , DOI: 10.1097/crd.0000000000000389
Yuichi Saito 1 , Takeshi Nishi 1 , Kan Saito 1 , Hideki Kitahara 1 , Yoshiaki Kawase 2 , Hitoshi Matsuo 2 , Yoshio Kobayashi 1
Affiliation  

The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) was eagerly awaited study in the field of ischemic heart disease. Following the presentation and publication of ISCHEMIA, multiple opinions and viewpoints get complicated. The ongoing debates have been including the relevance of coronary revascularization, noninvasive diagnostic methods, and invasive ischemic testing in patients with stable ischemic heart disease (SIHD). Prior to ISCHEMIA, observational studies indicated the potential of coronary revascularization for improving clinical outcomes, while the randomized Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial did not support the plausible concept. Although the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) 2 trial implied the superiority of percutaneous coronary intervention over medical therapy alone, the clinical relevance of coronary revascularization to improve outcomes and quality of life has been questioned. As a consequence, the ISCHEMIA trial did not demonstrate clear benefits in reducing clinical events but showed antianginal effects of revascularization. This landmark trial also suggested the difficulties of noninvasive ischemia testing rather than computed tomography angiography. Despite the complex results, the ISCHEMIA trial may simplify the clinical indications of coronary revascularization in patients with SIHD. Future publications from the ISCHEMIA trial and debates on the results will sharpen our thinking and understanding.



中文翻译:

医学和侵入性方法比较健康有效性国际研究的临床意义和争论

缺血性心脏病领域热切期待的国际研究比较健康有效性与医疗和侵入性方法 (ISCHEMIA)。随着 ISCHEMIA 的介绍和出版,多种观点和观点变得复杂起来。正在进行的争论包括冠状动脉血运重建、非侵入性诊断方法和侵入性缺血检测在稳定型缺血性心脏病 (SIHD) 患者中的相关性。在 ISCHEMIA 之前,观察性研究表明冠状动脉血运重建有可能改善临床结果,而利用血运重建和积极药物评估 (COURAGE) 的随机临床结果试验不支持这个看似合理的概念。尽管用于多血管评估的血流储备分数与血管造影 (FAME) 2 试验暗示经皮冠状动脉介入治疗优于单纯药物治疗,但冠状动脉血运重建与改善预后和生活质量的临床相关性一直受到质疑。因此,ISCHEMIA 试验并未显示出减少临床事件的明显益处,但显示了血运重建的抗心绞痛作用。这项具有里程碑意义的试验还表明了非侵入性缺血测试而不是计算机断层扫描血管造影的困难。尽管结果复杂,但 ISCHEMIA 试验可能会简化 SIHD 患者冠状动脉血运重建的临床适应症。ISCHEMIA 试验的未来出版物和对结果的辩论将加深我们的思考和理解。

更新日期:2022-08-11
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