Abstract 13800: Five-Year All-Cause Mortality in the Contemporary Coronary Artery Disease Patients Who Would Be Eligible for ISCHEMIA Trial

Abstract

Introduction: Landmark ISCHEMIA (ISCH) trial provided unique information, but the generalizability of its results into myocardial revascularization guidelines and practice has been met by unprecedented debate. Hypothesis: We aimed to compare the 5 year all-cause mortality (5y Mt) in our ISCH trial like patients (pts) with results in ISCH. Methods: After applying ISCH study inclusion/exclusion criteria we identified 854 pts from our prospective database of 2455 consecutive pts who had the first isolated CABG in 2012-2015 with complex CAD with 100% follow up (F-up) of 5y Mt. Results: Comparative characteristics of ISCH like and actual ISCH pts are presented in Table 1. Аll our pts underwent CABG, contrary to ISCH where CABG and PCI were used in 538 and 1532 pts, consecutively. Although in ISCH pts had high diversity of ethnicity, were older, had more DM2 (but less insulin dependent), and had previous PCI or CABG in 25%, our pts were strikingly sicker (lower LVEF, higher proportion of 3VD and proximal LAD, higher NYHA as well as more comorbidities) 5-year mortality was 8.9% compared to 9% in the Invasive arm of ISCH. Of note 48 h mortality from MI type 5 (post CABG) was 1.67% in ISCH, and 30-day Mt in our study was 1.30%, with complete revascularization in 95%. As expected by the disease severity treated by CABG early Mt was higher in our than ISCH pts (Figure 1). Conclusion: The present study findings outline that translation of results from the ISCHEMIA trial with practice-changing implications into recommendations for a local Heart Team discussion to advise the best treatment decision for patients with more complex forms of CAD is uncertain and requires further research activities.