Early invasive strategy does not reduce mortality for moderate to severe ischemic heart disease after 5.8 years (ISCHEMIA-EXTEND)

Clinical Question

For patients with moderate to severe reversible ischemic cardiac disease, does adding an initial invasive strategy to optimal medical therapy reduce mortality more than optimal medical therapy alone?

Bottom line

We all die of something. An early invasive strategy for patients with moderate to severe ischemic heart disease does not reduce mortality; at best, it shifts mortality from cardiovascular to noncardiovascular for those with multivessel disease. 1b

Study design: Randomized controlled trial (single-blinded)

Funding: Industry + govt

Setting: Outpatient (specialty)


Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

Discuss this POEM



Perplexing data on death rate with or without early invasive

Seems to make little sense. Cardiac related mortality overall reduced but overall mortality the same?

Arup Kumar Dhara

Impact assessment

Very good


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