Coronary Artery Disease Survival
Early invasive procedures for stable coronary artery disease do not extend long-term survival compared with medications and lifestyle changes alone, News-Medical reported.
The ISCHEMIA-EXTEND trial tracked more than 5,000 men and women across 37 countries for up to 13 years. Researchers at NYU Langone Health presented the findings on November 7 at the American Heart Association Scientific Sessions in Chicago, with simultaneous publication in the Journal of the American Medical Association.
Patients in the invasive group faced a 26 percent chance of death, while those managed conservatively faced a 27 percent chance. Tech Times reported that the 13-year survival curves yielded a hazard ratio of 0.97. Bioengineer.org noted that the study evaluated individuals with fatty plaque buildup limiting blood flow without causing complete heart attacks.
Symptom Relief Versus Longevity
“Our analyses make clear that while managing stable coronary artery disease with early heart procedures helps relieve chest pain and improves quality of life in those with chest pain, it is unlikely to help patients live longer,” said study co-lead author Dr. Judith S. Hochman, according to News-Medical.
For decades, physicians recommended opening narrowed arteries with stents or performing bypass surgery early to prevent future crises. The new data challenges that assumption for stable patients. Dr. Hochman emphasized that stents and bypass operations remain lifesaving for active heart attacks.
Tech Times noted an unexplained scientific puzzle within the data: invasive procedures reduced deaths from heart disease but increased deaths from other causes, most notably cancer. The two competing effects cancelled each other out.
Discussing radiation exposure during catheterization procedures
“Our results highlight the need for thoughtful discussions between patients with stable heart disease and their healthcare providers about goals and trade-offs,” said study co-lead author Dr. Rebecca Anthopolos, as reported by News-Medical.
Catheterization procedures expose patients to radiation doses ranging from several millisieverts to tens of millisieverts. A standard chest X-ray delivers about 0.1 millisieverts, while a chest CT scan delivers roughly 7 millisieverts, according to Tech Times.
Dr. Anthopolos noted that the trial did not track nonfatal heart attacks or repeat procedures after the initial trial phase.
What patients these findings apply to and study duration
What patients do these findings apply to?
The results apply specifically to individuals with stable coronary artery disease and abnormal stress tests. Patients experiencing active heart attacks still require immediate, lifesaving invasive procedures.
How long were patients tracked in the trial?
Researchers tracked participants for up to 13 years across 320 hospitals in 37 countries, recording 1,071 deaths.
What caused the similar survival rates?
While invasive procedures lowered cardiac deaths, Tech Times reported an offsetting rise in non-cardiac deaths, primarily from cancer, leaving overall mortality virtually identical.
Who funded the research?
The National Institutes of Health funded the ISCHEMIA-EXTEND study under grant R01HL149888.
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