PCI in the management of chronic coronary syndromes after the ISCHEMIA Study

Abstract

The role of percutaneous coronary intervention (PCI) in the management of chronic coronary syndromes (CCS) has long been a subject of debate. Numerous clinical trials have demonstrated limited benefit from revascularisation on hard clinical endpoints among patients with CCS. The latest of these studies, the International Study Of Comparative Health Effectiveness With Medical And Invasive Approaches (ISCHEMIA) trial, found no significant reduction in mortality or myocardial infarction from revascularisation in patients with CCS when compared with optimal medical therapy (OMT) alone. At face value, these results suggest that patients with significant ischaemia on stress testing no longer need to be rushed to the catheterisation laboratory. Instead, the focus should be on the instigation of guideline-recommended OMT, with PCI reserved for patients who remain symptomatic despite OMT. This article provides a review of the current evidence, including the findings of the ISCHEMIA trial, and assesses the potential implications for future clinical practice.