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Cardiovascular disease is the leading cause of death in the world. According to the American Heart Association, 17.3 million people die due to heart disease. This figure is expected to be more than 23.6 million by the year 2030. According to 2016 data, someone dies from cardiovascular disease every 38 seconds, approximately 2303 deaths a day.

Heart disease occurs due to blockage or clogging of heart arteries. Blockage takes place when cholesterol deposits build up inside the arteries. When the blockage becomes severe there can be symptoms like chest pain, shortness of breath, fatigue, dizziness. There are different ways to treat the blockages like medications, stents, open-heart surgery based on the patient's condition. Previous trials have shown that medications may work as well as stents in patients who have stable coronary heart disease. Stable coronary heart disease does not include patients with a heart attack or worsening cardiac symptoms. Let’s look at the recent study which evaluated different treatment strategies for stable heart disease patients.

ISCHEMIA TRIAL

In June 2019, the ISCHEMIA trial comparing invasive to conservative strategies for treating Stable Ischemic Heart Disease (SIHD) closed. The seven-year, unblinded study, conducted at NYU School of Medicine and chaired by Dr. Judith S. Hochman involved over 5000 participants from 500 countries. 

The trial involved stable heart disease patients with a moderately abnormal stress test. All the patients were treated with optimal medical therapy for heart disease. The patients were divided into two groups: Conservative group (Optimal medical therapy and cardiac catheterization only if failure of medical therapy) and Early invasive group (Optimal medical therapy and cardiac catheterization plus stent if needed). The purpose of attempting such early intervention was to determine whether or not invasive early treatment would prevent or prolong endpoints like heart attack, heart failure, death.

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During the study, 5179 patients were accepted and randomized into groups: 2588 received invasive treatment, while 2591 received conservative treatment. All patients received medication therapy, which included beta-blockers, anti-anginal and anti-platelet medications. Follow-up visits for all participants occurred at a rate of over 99%. The study administrators examined patient endpoints over a 3.5-year follow-up period, and the data graphed to compare results across groups.

The study concluded that early invasive surgery did not significantly reduce the risks associated with SIHD compared to a conservative strategy, which introduces surgery only when needed. This was the case with both the primary and secondary endpoints.

Conclusions

This study results are consistent with previous data from the COURAGE trial from 2007 that patients with stable heart disease may be treated with medications alone initially. 

Are the stents not needed at all? Be careful in interpreting these results as this study did not include patients with heart attack, cardiac arrest, unstable angina, heart failure. This study highlights the role of medical therapy in heart disease and role of cardiac catheterization and stents only after failure of medical therapy in stable heart disease.

Talk to your doctor today about the steps you can take to reduce your risk of heart disease.

References:

1.www.heart.org

2. https://professional.heart.org/professional/ScienceNews/UCM_505226_ISCHEMIA-Clinical-Trial-Details.jsp

3.https://www.nejm.org/doi/full/10.1056/NEJMoa070829

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