ISCHEMIA trial:How to apply the results to clinical practice

作     者：Rafael Vidal-Perez Alberto Bouzas-Mosquera Jesus Peteiro Jose Manuel Vazquez-Rodriguez 

作者机构：Servicio de CardiologiaUnidad de Imagen y Funcion CardiacaComplexo Hospitalario Universitario A Coruna(CHUAC)Centro de Investigacion Biomedica en Red(CIBERCV)-Instituto de Salud Carlos IIIA Coruna 15006Spain Servicio de CardiologíaComplexo Hospitalario Universitario A CoruñaA Coruña 15006Spain 

出 版 物：《World Journal of Cardiology》 (世界心脏病学杂志（英文版）（电子版）)

年 卷 期：2021年第13卷第8期

页      面：237-242页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Stable angina Chronic coronary syndrome ISCHEMIA Stress testing Therapy Diagnosis 

摘      要：During the last years two questions have been continuously asked in chronic coronary syndromes:(1)Do revascularization procedures(coronary artery bypass grafting or percutaneous coronary intervention)really improve symptoms of angina?and(2)Do these techniques improve outcomes,*** they prevent new myocardial infarction events and cardiovascular death?Therefore,there was a need for a large definitive *** study was the ISCHEMIA trial,a large,multicentric trial sponsored by the National Heart,Lung,and Blood *** main trial compared coronary revascularization and optimal medical treatment(OMT)vs OMT alone in 5179 patients enrolled after a stress *** a median 3.2-year follow-up,318 primary outcome events occurred;the adjusted hazard ratio for the invasive strategy as compared with the conservative strategy was 0.93(95%confidence interval 0.80-1.08,P=0.34).The ISCHEMIA trial deeply disrupted many of our prior attitudes regarding management strategies for patients with stable coronary artery *** findings underscore the benefits of disease-modifying OMT for stable coronary artery disease *** main purposes of ischemia assessment before this trial were:Diagnostic purposes,assessment of outcome,and adding to decision-making ***,this changed after the trial *** results of ISCHEMIA might challenge the current diagnostic approach for stable angina patients recommended in the last European Society of Cardiology guidelines on chronic coronary disease that were based on studies published before the ISCHEMIA *** this editorial we propose our approach based on the ISCHEMIA study and the pretest probability for a positive test in patients with chronic coronary syndromes.