Abstract
The goal of a large, prospective, randomized clinical trial, ISCHEMIA, was to evaluate a routine invasive treatment strategy compared to optimal drug therapy in patients with stable ischemic heart disease (IHD). At first glance, the question of the effect of coronary revascularization on the natural course of stable IHD received a definitive negative answer. However, excessive pessimism regarding coronary revascularization due to the results of the ISCHEMIA study is not justified and when interpreting the results of the project, it is necessary to take into account the criteria for exclusion of patients, conducting revascularization in some patients from the group of drug therapy. Meanwhile, already at present, a significant part of the resources used for widespread revascularization with stable IHD should be directed toward achieving the new goals of lipid-lowering therapy recommended by experts, the use of prognostically effective combined antithrombotic treatment and rational combinations of antianginal drugs.
Highlights
The goal of a large, prospective, randomized clinical trial, ISCHEMIA, was to evaluate a routine invasive treatment strategy compared to optimal drug therapy in patients with stable ischemic heart disease (IHD)
Excessive pessimism regarding coronary revascularization due to the results of the ISCHEMIA study is not justified and when interpreting the results of the project, it is necessary to take into account the criteria for exclusion of patients, conducting revascularization in some patients from the group of drug therapy
Already at present, a significant part of the resources used for widespread revascularization with stable IHD should be directed toward achieving the new goals of lipid-lowering therapy recommended by experts, the use of prognostically effective combined antithrombotic treatment and rational combinations of antianginal drugs
Summary
Целью крупного проспективного клинического исследования ISCHEMIA была оценка рутинной инвазивной стратегии лечения по сравнению с оптимальной медикаментозной терапией среди пациентов со стабильной ИБС. Около 3000 пациентов не были включены в исследование из-за выявления стеноза ствола левой коронарной артерии (~ 5 % случаев) с помощью компьютерной томографии или наличия необструктивной формы ИБС или заключения об отсутствии достаточной степени ишемии (всего ~ 25 %).
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