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In a retrospective analysis of the ISCHEMIA trial, patients undergoing early revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) had higher early risks, particularly after CABG, but lower long-term cardiovascular event risks compared to those with a conservative approach.

The following is a summary of “Outcomes According to Coronary Revascularization Modality in the ISCHEMIA Trial,” published in the February 2024 issue of Cardiology by Redfors et al.

In the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial, which focused on patients with stable coronary artery disease, those undergoing an invasive (INV) strategy involving angiography with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), and those opting for coronary revascularization and a conservative (CON), exhibited similar risks of ischemic events.

Researchers conducted a retrospective study to analyze the outcomes of patients undergoing invasive treatment with either PCI or CABG separately in the ISCHEMIA trial.

They classified patients without prior primary outcome events into INV-PCI or INV-CABG groups starting from revascularization. The ISCHEMIA primary outcome, which consisted of a composite of cardiovascular death, protocol-defined myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest, was utilized in this categorization process.

The results showed that 84 out of 512 (16.4%) experienced primary outcome events among INV-CABG patients over a median follow-up of 2.85 years. 48 events (57.1%) occurred within 30 days post-CABG, including 40 procedural MIs. Among INV-PCI patients, 147/1,500 (9.8%) had primary outcome events during a median follow-up of 2.94 years. In the cohort, 31 events (21.1%) happened within 30 days post-PCI, including 24 procedural MIs. In comparison, 352 out of 2,591 CON patients (13.6%) experienced primary outcome events over a median follow-up of 3.2 years, with 22 events (6.3%) occurring within 30 days of randomization. The adjusted risks of primary outcomes were significantly higher after both CABG and PCI within 30 days (HR: 16.25 [95% CI: 11.44-23.07] and HR: 2.99 [95% CI: 1.97-4.53]) and lower after that (HR: 0.63 [95% CI: 0.44-0.89] and HR: 0.66 [95% CI: 0.53-0.82]).

Investigators concluded that early revascularization in ISCHEMIA carried higher early risks (especially after CABG), which led to lower long-term cardiovascular event risks compared to conservative management.

Source: jacc.org/doi/10.1016/j.jacc.2023.11.002