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Gene Expression Signature in Patients With Symptomatic Peripheral Artery Disease
Newman, Jonathan D; Cornwell, MacIntosh G; Zhou, Hua; Rockman, Caron; Heguy, Adriana; Suarez, Yajaira; Cheng, Henry S; Feinberg, Mark W; Hochman, Judith S; Ruggles, Kelly V; Berger, Jeffrey S
OBJECTIVE:<0.05, |log2foldchange| >0.5) and analyzed using weighted gene co-expression network analysis. Weighted gene co-expression network analysis revealed blood modules enriched for immune activation, secretory granules, and coagulation in patients with PAD. Of these 127 differentially expressed transcripts, 40 were significantly associated with MACLE (log-rank false discovery rate <0.1). MicroRNA-4477b was significantly increased in patients with PAD with subsequent MACLE and in a mouse hindlimb ischemia model. CONCLUSIONS:A whole blood transcript signature identified patients with symptomatic PAD and PAD patients at increased risk of MACLE. A previously uncharacterized transcript microRNA-4477b was overexpressed in prevalent PAD, incident MACLE, and in a mouse hindlimb ischemia model. Our novel transcriptomic signature provides insight into potential mechanisms of patients with severe symptomatic PAD.
PMID: 33657880
ISSN: 1524-4636
CID: 4801612
Multiple Biomarker Approach to Risk Stratification in COVID-19 [Letter]
Smilowitz, Nathaniel R; Nguy, Vuthy; Aphinyanaphongs, Yindalon; Newman, Jonathan D; Xia, Yuhe; Reynolds, Harmony R; Hochman, Judith S; Fishman, Glenn I; Berger, Jeffrey S
PMID: 33587646
ISSN: 1524-4539
CID: 4786532
Risk of thrombotic events after respiratory infection requiring hospitalization
Smilowitz, Nathaniel R; Subashchandran, Varun; Newman, Jonathan; Barfield, Michael E; Maldonado, Thomas S; Brosnahan, Shari B; Yuriditsky, Eugene; Horowitz, James M; Shah, Binita; Reynolds, Harmony R; Hochman, Judith S; Berger, Jeffrey S
Thrombosis is a major concern in respiratory infections. Our aim was to investigate the magnitude and duration of risk for arterial and venous thrombosis following discharge after respiratory infection. Patients with respiratory infections were identified using the United States Nationwide Readmission Database from 2012 to 2014. Patients admitted with asthma or cellulitis served as comparators. Readmissions for acute myocardial infarction (MI) and venous thromboembolism (VTE) were evaluated at 30 to 180Â days. The likelihood of a first thrombotic event after discharge was compared with a 30-day period prior to hospitalization. Among 5,271,068 patients discharged after a respiratory infection, 0.56% and 0.78% were readmitted within 30-days with MI and VTE, respectively. Relative to asthma and cellulitis, respiratory infection was associated with a greater age and sex-adjusted hazard of 30-day readmission for MI (adjusted HR [aHR] 1.48 [95% CI 1.42-1.54] vs. asthma; aHR 1.36 [95% CI 1.31-1.41] vs. cellulitis) and VTE (aHR 1.28 [95% CI 1.24-1.33] vs. asthma; aHR 1.26, [95% CI 1.22-1.30] vs. cellulitis). Risks of MI and VTE attenuated over time. In a crossover-cohort analysis, the odds of MI (OR 1.68 [95% CI 1.62-1.73]) and VTE (OR 3.30 [95% 3.19-3.41]) were higher in the 30Â days following discharge after respiratory infection than during the 30-day baseline period. Hospitalization for respiratory infection was associated with increased risks of thrombosis that were highest in the first 30-days after discharge and declined over time.
PMID: 33602977
ISSN: 2045-2322
CID: 4787172
C-reactive protein and clinical outcomes in patients with COVID-19
Smilowitz, Nathaniel R; Kunichoff, Dennis; Garshick, Michael; Shah, Binita; Pillinger, Michael; Hochman, Judith S; Berger, Jeffrey S
BACKGROUND:A systemic inflammatory response is observed in coronavirus disease 2019 (COVID-19). Elevated serum levels of C-reactive protein (CRP), a marker of systemic inflammation, are associated with severe disease in bacterial or viral infections. We aimed to explore associations between CRP concentration at initial hospital presentation and clinical outcomes in patients with COVID-19. METHODS AND RESULTS/RESULTS:Consecutive adults aged ≥18 years with COVID-19 admitted to a large New York healthcare system between 1 March and 8 April 2020 were identified. Patients with measurement of CRP were included. Venous thrombo-embolism (VTE), acute kidney injury (AKI), critical illness, and in-hospital mortality were determined for all patients. Among 2782 patients hospitalized with COVID-19, 2601 (93.5%) had a CRP measurement [median 108 mg/L, interquartile range (IQR) 53-169]. CRP concentrations above the median value were associated with VTE [8.3% vs. 3.4%; adjusted odds ratio (aOR) 2.33, 95% confidence interval (CI) 1.61-3.36], AKI (43.0% vs. 28.4%; aOR 2.11, 95% CI 1.76-2.52), critical illness (47.6% vs. 25.9%; aOR 2.83, 95% CI 2.37-3.37), and mortality (32.2% vs. 17.8%; aOR 2.59, 95% CI 2.11-3.18), compared with CRP below the median. A dose response was observed between CRP concentration and adverse outcomes. While the associations between CRP and adverse outcomes were consistent among patients with low and high D-dimer levels, patients with high D-dimer and high CRP have the greatest risk of adverse outcomes. CONCLUSIONS:Systemic inflammation, as measured by CRP, is strongly associated with VTE, AKI, critical illness, and mortality in COVID-19. CRP-based approaches to risk stratification and treatment should be tested.
PMID: 33448289
ISSN: 1522-9645
CID: 4785432
Coronary CT Angiography Followed by Invasive Angiography in Patients With Moderate or Severe Ischemia-Insights From the ISCHEMIA Trial
Mancini, G B John; Leipsic, Jonathan; Budoff, Matthew J; Hague, Cameron J; Min, James K; Stevens, Susanna R; Reynolds, Harmony R; O'Brien, Sean M; Shaw, Leslee J; Manjunath, Cholenahally N; Mavromatis, Kreton; Demkow, Marcin; Lopez-Sendon, Jose Luis; Chernavskiy, Alexander M; Gosselin, Gilbert; Schuchlenz, Herwig; Devlin, Gerard P; Chauhan, Anoop; Bangalore, Sripal; Hochman, Judith S; Maron, David J
OBJECTIVES/OBJECTIVE:This study aimed to examine the concordance of coronary computed tomographic angiography (CCTA) assessment of coronary anatomy and invasive coronary angiography (ICA) as the reference standard in patients enrolled in the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA). BACKGROUND:Performance of CCTA compared with ICA has not been assessed in patients with very high burdens of stress-induced ischemia and a high likelihood of anatomically significant coronary artery disease (CAD). A blinded CCTA was performed after enrollment to exclude patients with left main (LM) disease or no obstructive CAD before randomization to an initial conservative or invasive strategy, the latter guided by ICA and optimal revascularization. METHODS:Rates of concordance were calculated on a per-patient basis in patients randomized to the invasive strategy. Anatomic significance was defined as ≥50% diameter stenosis (DS) for both modalities. Sensitivity analyses using a threshold of ≥70% DS for CCTA or considering only CCTA images of good-to-excellent quality were performed. RESULTS:In 1,728 patients identified by CCTA as having no LM disease ≥50% and at least single-vessel CAD, ICA confirmed 97.1% without LM disease ≥50%, 92.2% with at least single-vessel CAD and no LM disease ≥50%, and only 4.9% without anatomically significant CAD. Results using a ≥70% DS threshold or only CCTA of good-to-excellent quality showed similar overall performance. CONCLUSIONS:CCTA before randomization in ISCHEMIA demonstrated high concordance with subsequent ICA for identification of patients with angiographically significant disease without LM disease.
PMID: 33454249
ISSN: 1876-7591
CID: 4760142
Myocardial Infarction in the ISCHEMIA Trial: Impact of Different Definitions on Incidence, Prognosis, and Treatment Comparisons
Chaitman, Bernard R; Alexander, Karen P; Cyr, Derek D; Berger, Jeffrey S; Reynolds, Harmony R; Bangalore, Sripal; Boden, William E; Lopes, Renato D; Demkow, Marcin; Perna, Gian Piero; Riezebos, Robert K; McFalls, Edward O; Banerjee, Subhash; Bagai, Akshay; Gosselin, Gilbert; O'Brien, Sean M; Rockhold, Frank W; Waters, David D; Thygesen, Kristian A; Stone, Gregg W; White, Harvey D; Maron, David J; Hochman, Judith S
Background: In ISCHEMIA, an initial invasive strategy did not significantly reduce rates of cardiovascular events or all-cause mortality compared with a conservative strategy in patients with stable ischemic heart disease and moderate/severe myocardial ischemia. The most frequent component of composite cardiovascular endpoints was myocardial infarction. Methods: ISCHEMIA prespecified that the primary and major secondary composite endpoints of the trial be analyzed using two MI definitions. For procedural MI, the primary MI definition used CK-MB as the preferred biomarker whereas the secondary definition used cardiac troponin. Procedural thresholds were >5 times URL for PCI and >10 times for CABG. Procedural MI definitions included (i) a category of elevated biomarker only events with much higher biomarker thresholds (ii) new ST segment depression of ≥ 1mm for the primary and ≥ 0.5 mm for the secondary definition and (iii) new coronary dissections ≥ NHLBI grade 3. We compared MI type, frequency, and prognosis by treatment assignment using both MI definitions. Results: Procedural MI's accounted for 20.1% of all MI events with the primary definition and 40.6% of all MI events with the secondary definition. Four-year MI rates in patients undergoing revascularization were more frequent with the invasive vs conservative strategy using the primary [2.7% vs. 1.1%; adjusted HR 2.98 (95% CI 1.87, 4.73)] and secondary [8.2% vs. 2.0%; adjusted HR 5.04 (95% CI 3.64, 6.97)] MI definitions. Type 1 MI's were less frequent with the invasive vs conservative strategy using the primary [3.40% vs. 6.89%; adjusted HR 0.53 (95% CI 0.41,0.69); p<0.0001], and secondary [3.48% vs 6.89%; adjusted HR 0.53 (95% CI 0.41, 0.69); p<0.0001] definitions. The risk of subsequent cardiovascular death was higher after a type 1 MI compared to no MI using the primary [adjusted HR 3.38 (95% CI 2.03,5.61); p<0.001] or secondary MI definition [adjusted HR 3.52 (2.11, 5.88); p<0.001]. Conclusions: In ISCHEMIA, type 1 MI events using the primary and secondary definitions during 5-year follow-up were more frequent with an initial conservative strategy and associated with subsequent cardiovascular death. Procedural MI rates were greater in the invasive strategy and using the secondary MI definition. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT01471522.
PMID: 33267610
ISSN: 1524-4539
CID: 4694232
Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of MINOCA in Women
Reynolds, Harmony R; Maehara, Akiko; Kwong, Raymond Y; Sedlak, Tara; Saw, Jacqueline; Smilowitz, Nathaniel R; Mahmud, Ehtisham; Wei, Janet; Marzo, Kevin; Matsumura, Mitsuaki; Seno, Ayako; Hausvater, Anais; Giesler, Caitlin; Jhalani, Nisha; Toma, Catalin; Har, Bryan; Thomas, Dwithiya; Mehta, Laxmi S; Trost, Jeffrey; Mehta, Puja K; Ahmed, Bina; Bainey, Kevin R; Xia, Yuhe; Shah, Binita; Attubato, Michael; Bangalore, Sripal; Razzouk, Louai; Ali, Ziad A; Bairey-Merz, C Noel; Park, Ki; Hada, Ellen; Zhong, Hua; Hochman, Judith S
Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in 6-15% of MI and disproportionately affects women. Scientific statements recommend multi-modality imaging in MINOCA to define the underlying cause. We performed coronary optical coherence tomography (OCT) and cardiac magnetic resonance imaging (CMR) to assess mechanisms of MINOCA. Methods: In this prospective, multicenter, international, observational study, we enrolled women with a clinical diagnosis of MI. If invasive coronary angiography revealed <50% stenosis in all major arteries, multi-vessel OCT was performed, followed by CMR (cine imaging, late gadolinium enhancement, and T2-weighted imaging and/or T1 mapping). Angiography, OCT, and CMR were evaluated at blinded, independent core laboratories. Culprit lesions identified by OCT were classified as definite or possible. The CMR core laboratory identified ischemia-related and non-ischemic myocardial injury. Imaging results were combined to determine the mechanism of MINOCA, when possible. Results: Among 301 women enrolled at 16 sites, 170 were diagnosed with MINOCA, of whom 145 had adequate OCT image quality for analysis; 116 of these underwent CMR. A definite or possible culprit lesion was identified by OCT in 46.2% (67/145) of participants, most commonly plaque rupture, intra-plaque cavity or layered plaque. CMR was abnormal in 74.1% (86/116) of participants. An ischemic pattern of CMR abnormalities (infarction or myocardial edema in a coronary territory) was present in 53.4% of participants undergoing CMR (62/116). A non-ischemic pattern of CMR abnormalities (myocarditis, takotsubo syndrome or non-ischemic cardiomyopathy) was present in 20.7% (24/116). A cause of MINOCA was identified in 84.5% of the women with multi-modality imaging (98/116), higher than with OCT alone (p<0.001) or CMR alone (p=0.001). An ischemic etiology was identified in 63.8% of women with MINOCA (74/116), a non-ischemic etiology was identified in 20.7% (24/116), and no mechanism was identified in 15.5% (18/116). Conclusions: Multi-modality imaging with coronary OCT and CMR identified potential mechanisms in 84.5% of women with a diagnosis of MINOCA, three-quarters of which were ischemic and one-quarter of which were non-ischemic, alternate diagnoses to MI. Identification of the etiology of MINOCA is feasible and has the potential to guide medical therapy for secondary prevention. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02905357.
PMID: 33191769
ISSN: 1524-4539
CID: 4672212
Management of Coronary Disease in Patients with Advanced Kidney Disease
Bangalore, Sripal; Maron, David J; O'Brien, Sean M; Fleg, Jerome L; Kretov, Evgeny I; Briguori, Carlo; Kaul, Upendra; Reynolds, Harmony R; Mazurek, Tomasz; Sidhu, Mandeep S; Berger, Jeffrey S; Mathew, Roy O; Bockeria, Olga; Broderick, Samuel; Pracon, Radoslaw; Herzog, Charles A; Huang, Zhen; Stone, Gregg W; Boden, William E; Newman, Jonathan D; Ali, Ziad A; Mark, Daniel B; Spertus, John A; Alexander, Karen P; Chaitman, Bernard R; Chertow, Glenn M; Hochman, Judith S; Abdallah, Abdallah M; Moreyra, Abel E; Laddu, Abhay A; Dubey, Abhishek; Goyal, Abhishek; Knighton, Abigail; Adeboye, Adedayo; Juceviciene, Agne; Urboniene, Agne; Szramowska, Agnieszka; Abdel-Latif, Ahmed; Ayoub, Ahmed; Elghamaz, Ahmed; Kamal, Ahmed; Talaat, Ahmed; Sharma, Ajay; Narula, Ajit Singh; Bagai, Akshay; Smigelskaite, Akvile; Raymond, Alain; Rheault, Alain; Loehr, Alaine Melanie; Varga, Albert; Maggioni, Aldo P; Moorman, Alec; Chevaile Ramos, Alejandro; Gisbert, Alejandro; Fratczak, Aleksandra; Laucevicius, Aleksandras; Chernyavskiy, Alexander M; Borisov, Alexander Sergeevich; Craft, Alexandra; Hunter, Alexandra; Hueb, Alexandre Ciappina; Schaan de Quadros, Alexandre; Muller, Alice Manica; Deiro, Aline Peixoto; Stone, Allegra; Castro, Almudena; Uxa, Amar; Van Craenenbroeck, Amaryllis; Roy, Ambuj; Kakkar, Amit; Flowers, Amy; Iskandrian, Amy; Djordjevic-Dikic, Ana D; Gomes Almeida, Ana; Francisco, Ana Rita; Mladenovic, Ana S; Santana, Ana; Lahiri, Anandaroop; Kuzmina-Krutetskaya, Anastasia M; Vamvakidou, Anastasia; Vertes, Andras; Gabriel, Andre; Bartykowszki, Andrea; Lorimer, Andrea; Pascual, Andrea; Coelho, Andreia; Rocha, Andreia; GarcÃa-Rincón, Andrés; Starovoytov, Andrew; Åabyk, Andrzej; Kawakami, Anelise; Hoye, Angela; Nobre, Angelo; Acharya, Anjali; Anand, Anjali; Rishmawi, Anjana; Banfield, Ann; Luyten, Ann; Cichocka-Radwan, Anna; Fojt, Anna; Plachcinska, Anna; Teresinska, Anna; Webb, Anne Marie; Heath, Anne; Mathew, Anoop; Vega, Antonia; Carvalho, Antonio; Colombo, Antonio; Fiarresga, Antonio; Tharini, Anu; Rao, Anupama; Valdespino-Estrada, Aquiles; Diaz, Ariel; Asif, Arif; Seto, Arnold H; Campos-Santaolalla, Arturo S; Cheema, Asim N; Ahmed, Asker; Mathur, Atul; Leong, Audrey W; Ã…kerblom, Axel; Fuentes, Axelle; Naher, Aynun; Valaiyapathi, Badhma; Srinivasan, Balaji; Kaur, Baljeet; Bhargava, Balram; Guruge, Bandula; Wicklund, Barbara; Czarniak, Bartosz; Singh, Bebek; Igual, Begoña; Merkely, Bela; Shah, Benoy N; de Bruyne, Bernard; Abramson, Beth; Stefanchik, Beth; Harvey, Bethany; Shivalkar, Bharati; Malik, Bilal; Kurian, Binoy Mannekkattukudy; Hammouche, Bougrida; Beleslin, Branko D; Ferguson, Bruce; McManus, Bruce; Ascoli, Bruna Maria; Smith, Bryn; Allen, Byron J; Gibson, C Michael; Bairey Merz, C Noel; Pop, Calin; Gagné, Carl-Éric; Ohmart, Carly; Kartje, Carol M; Alsweiler, Caroline; Rodgers, Caroline; Spindler, Caroline; Gruber, Carolyn J; Albert, Catherine; Bone, Catherine; Lemay, Catherine; Kepka, Cezary; Suvarna, Chandini; Mercure, Chantale; Wiyarand, Charlene; Patel, Chetan; Attanasio, Chiara; Chow, Chi-Ming; Er, Ching Min; Ong, Ching-Ching; Manjunath, Cholenahally Nanjappa; Buller, Chris; Vassaliere, Christel; Vrints, Christiaan; Witzke, Christian; Ballantyne, Christie; Björklund, Christina; Roraff, Christine; Laure, Christophe; Thuaire, Christophe; Chan, Christopher; Fordyce, Christopher; Kinsey, Christopher; Xia, Chunli; Schultz, Cidney; Held, Claes; Cortés, Claudia; Escobar, Claudia; Freixo, Cláudia; Kadalie, Clemens T; Thobois, Corine; Page, Courtney; Bare, Cristina; Espinosa, Dalisa; Gao, Dan; Rizk, Dana; Puzhevsky, Daniela; Analyst, Data; Charytan, David M; Williams, David O; Booth, David; Charytan, David; Cohen, David; DeMets, David; Foo, David; Goldfarb, David; Schlichting, David; Sisson, David; Taggart, David; Waters, David; Wheeler, David; Williams, David; Vo, Davis; Teodorczyk, Dawid; Shelstad, Dawn D; Kereiakes, Dean; Yip, Deborah; Ramaswamy, Deepa; Mattina, Deirdre; Murphy, Deirdre; Jiang, Dengke; Cyr, Derek; Cukali, Diana; Camara, Diane; Stournaras, Dimitrios; Patel, Dipti; Li, Dongze; Exley, Donna; Reimann, Doreen; Schwartz, Doron; Cacela, Duarte; Conway, Dwayne S G; Punnoose, Eapen; Tay, Edgar L; Karanjah, Edgar; Gomes Lima, Eduardo; Hernandez-Rangel, Eduardo; Nicol, Edward D; Kaczmarska, Edyta; Refoyo Salicio, Elena; Feen, Eli; Durán-Cortés, Elihú; Janzen, Elisabeth M; van Dongen, Elise; Restelli Piloto, Elissa; Srbinovska Kostovska, Elizabeta; Capasso-Gulve, Elizabeth; Zbyshevskaya, Elizaveta V; Fridell, Ellie; Lader, Ellis W; Gosmanova, Elvira; Tachot, Emilie; Howard, Emma; Sorbets, Emmanuel; Alonso-Ãlvarez, Encarnación; Daugas, Eric; Alexánderson Rosas, Erick; Montpetit, Estelle; Passamani, Eugene; Shutov, Evgeny; Szczerba, Ewa; Wojtala, Ewelina; Ribeiro Silva, Expedito Eustáquio; Fimiani, Fabio; Hage, Fadi; Jafary, Fahim Haider; Feng, Fang; Ranjbaran, Fatima; Pinto, Fausto J; Caeiro, Fernando; Nolasco, Fernando; Silva, Filipa; Ottani, Filippo; Al Solaiman, Firas; Egydio, Flávia; Chereches, Florina; De Micco, Francesca; Bianchini, Francesca; Pietrucci, Francesca; Orso, Francesco; Pisano, Francesco; Patuleia Figueiras, Francisca; Madore, François; Harrell, Frank; Rockhold, Frank; Van de Werf, Frans; Guenther, Franziska; Mohr, Fred; Karthikeyan, G; Galeote, Gabriel; Grossmann, Gabriel; Steg, Gabriel; Guzman, Gabriela; Gabrielli, Gabriele; Chen, Gang; Sharma, Gautam; Petty, Gaylin; Mikolaitiene, Gelmina; Yee, Gennie; Devlin, Gerard Patrick; Esposito, Gerard; Ãgoston, Gergely; Lamas, Gervasio; Cobb, Gia; Perna, Gian Piero; Leone, Gianpiero; Mishra, Girish; Barge-Caballero, Gonzalo; Young, Grace M; Scaro, Graciela; Wong, Graham; Pressman, Gregg; Simonis, Gregor; Steinmaurer, Gudrun; Portugal, Guilherme; Cantinho Lopes, Guilhermina; Garcia-Garcia, Guillermo; Wang, Guoqin; Wander, Gurpreet S; Gulati, Gurpreet; Zhang, Haibo; Marciniak, Halina; Dai, Hao; Dong, Haojian; Franch, Harold; White, Harvey; Elabd, Hatem; Pomeroy, Hayley; Golden, Heather; Wilson, Heidi; Abergel, Helene; Siddaram, Hemalata; Mahapatra, Hemant Shakhar; Stokes, Henry C; Osseni, Hermine; Schuchlenz, Herwig; Skali, Hicham; Mattix-Kramer, Holly; Cheng, Hong; Mahrous, Hossam; Pejkov, Hristo; Marques, Hugo; Zhong, Hui; El Fishawy, Hussien; Webb, Ian; Kullo, Iftikhar; Grazhdankin, Igor O; Hassan, Ikraam; Pina, Ileana L; Tamasauskiene, Ilona; Cabrita, Inês Zimbarra; Rodrigues, Ines; Soveri, Inga; Mitevska, Irena Peovska; Lang, Irene Marthe; Subbotina, Irina; Kalibataite-Rutkauskiene, Irma; Roy, Isabelle; Tejani, Ishita; Naryshkin, Ivan A; Jankovic, Ivana; Niedzwiecka, Iwona; Kusmierek, Jacek; Chow, Jackie; Heo, Jaekyeong; Maksym, Jakub; Davies, James E; Jang, James J; Hirsch, James; Tatoulis, James; Henzel, Jan; Oliveira, Janaina; Rangaswami, Janani; Eckstein, Jane; Raj, Janitha; Pozzibon, Jaqueline; Drozdz, Jaroslaw; Kwok Kong, Jason Loh; Call, Jason T; Linefsky, Jason; Garcia, Javier J; Meisner, Jay; Scales, Jayne; Juliard, Jean Michel; Diodati, Jean; Juliard, Jean-Michel; Russo, Jeanne; Schoep, Jeannette J M; Leimberger, Jeff; Milliken, Jeffrey C; Anderson, Jeffrey; Kanters, Jeffrey; Lorin, Jeffrey; Moses, Jeffrey; Stepanovic, Jelena J; Celutkiene, Jelena; Stojkovic, Jelena; Jose, Jenne M; Stanford, Jennifer L; Hogan, Jennifer; Horst, Jennifer; Isaacs, Jennifer; Thomson, Jennifer; Tomfohr, Jennifer; White, Jennifer; Yee, Jerry; Berg, Jessica; Peteiro, Jesus; Peteiro, Jesús; Li, Jia; Liu, Jiamin; Zhang, Jianxin; Marcus, Jill; Blankenship, Jim; Dong, Jing; Chen, Jiyan; Evans, Jo; Peñafiel, JoaquÃn V; Sabik, Joe; Christopher, Johann; Kostis, John B; Graham, John Joseph; Doan, John; Jose, John; Kotter, John; Lehman, John; Middleton, John; Pownall, John; Gleadle, Jonathan M; Chavez-Iñiguez, Jonathan S; Byrne, Jonathan; Himmelfarb, Jonathan; Lebowitz, Jonathan; Thorsen, Jonean; Carrillo Calvillo, Jorge; Escobedo, Jorge; Ortega-RamÃrez, José A; Cuenca-Castillo, José J; Diez, Jose L; Narro Villanueva, José Luis; da Costa Vieira, José Luiz; Flores-Palacios, José M; Fragata, Jose; Lopes, Jose; Lopez-Sendon, Jose; Lopez-Sendon, José; Rueda, Jose; Selvanayagam, Joseph B; Sacco, Joseph; Loh, Joshua P; Burkhardt, Joy; López Quijano, Juan Manuel; Gaztanaga, Juan; Sebo, Judit; Wright, Judith; Stumpf, Juergen; de Aveiro Morata, Julia; Figal, Julio César; Hernandez Jaras, Julio; Yang, Junqing; Garg, Jyotsna; Rani, K Manjula; Preethi, K; Goetschalckx, Kaatje; Calfas, Karen; Petrosyan, Karen; Servilla, Karen; Swan, Karen; Ploetze, Karin; Kryczka, Karolina; Wojtczak-Soska, Karolina; Wojtera, Karolina; Ramasamy, Karthik; Åuczak, Katarzyna; Malinowska, Katarzyna; Knaut, Katharina; Martin, Katherine; Claes, Kathleen; Mason, Kathryn; Mahaffey, Ken; Gin, Kenneth; Lee, Kerry; Bonin, Kerstin; Mikes, Kerstin; Bainey, Kevin R; Harley, Kevin T; Marzo, Kevin; McMahon, Kevin; Abdul-Nour, Khaled; Alfakih, Khaled; Dajani, Khaled; Kushniriuk, Khrystyna; Poh, Kian-Keong; Holland, Kim; Halverson, Kimberly E; Murphy, Kinnari; Reddy, Kiran; Quiles, Kirsten J; Abercrombie, Kirsty; Matschke, Klaus; Szymczyk, Konrad; Chan, Koo Hui; Mavromatis, Kreton; Hongalgi, Krishnakumar; Thygesen, Kristian; Salmi, Kristin M; Newby, Kristin; Arges, Kristine; Teoh, Kristine; Drzymalski, Krzysztof; Kumbar, Lalathaksha; Matics, Laszlone; Hickson, LaTonya J; Keinaite, Laura; Sarti, Laura; True, Laura; Phillips, Lawrence M; Friedman, Lawrence; Maranan, Leandro C; Lotaif, Leda; Dharmarajan, Lekshmi; Bockeria, Leo A; Pizzol Caetano, Leonardo; Bridi, Leonardo; Bershtein, Leonid L; Yan, Li Hai; Li, Li; Sousa, Lidia; Xu, Lihong; Zhang, Lihua; Zhang, Lili; Mazza Barbosa, Lilian; Tozija, Liljana; Arcand, Linda; Patricio, Lino; Zhang, Liping; Hatch, Lisa; Jiang, Lixin; Low, Liz; Salman, Loay; Lopez, Lorena; Pritchard, Lori; Bernanrdes, Luis; Guzman, Luis; Teo, Lynette L; Reddy, M Sowjanya; Simoons, Maarten; Konigstein, Maayan; Selas, Mafalda; Madero, Magdalena; Miller, Magdalena; Misztal-Teodorczyk, Magdalena; Abdelhamid, Magdy; Fahim, Magid; Mylarappa, Mahevamma; Joseph, Majo X; Frach, Malgorzata; Rani, Manjula; Galvani, Marcello; Demkow, Marcin; Szkopiak, Marcin; De Fabritis, Marco; Magnoni, Marco; Marini, Marco; Sicuro, Marco; Roik, Marek; Alfonso, Maria A; Pereira de Moraes, Maria Antonieta; MartÃnez-RuÃz, MarÃa Dolores; Canziani, Maria Eugenia; Martin, Maria Eugenia; Caetano, Maria Inês; Corral, Maria P; Pérez GarcÃa, Maria; Andreasson, Maria; Posada, Maria; Dracoulakis, Marianna D A; Rubio, Mariano; Petrovic, Marija T; Vieira, Marina; Garcia, Mario J; D'arezzo, Mario; Orgera, Maris; Miglinas, Marius; Garand, Mark; Peterson, Mark; Xavier, Mark; Mosley, Marlowe; Capinha, Marta; Swiderek, Marta; Meyer, Martha; Ceseri, Martina; Tricoli, Martinia; Wiilliams, Mary; Champagne, Mary Ann; Streif, Mary; Leesar, Massoud; Claudia, Matei; Solecki, Mateusz; Mungo, MatÃas Nicolás; Shinseki, Matthew; Weir, Matthew; Nédio, Maura Carina; Winter, Max-Paul; Krishnam, Mayil S; Mishra, Meenakshi; Hwang, Mei; Srilatha, Melemadathil; LeFevre, Melissa; Simegn, Mengistu; Gibson, Michael A; Rubens, Michael B; Shapiro, Michael D; Chobanian, Michael; Davidson, Michael; Farkouh, Michael; Mack, Michael; Wlodarczyk, Michal; Khouri, Michel G; Crowder, Michelle; Ratliff, Michelle; Borges Santos, Miguel; Nobre Menezes, Miguel; Perez Fontan, Miguel; Barrero, Miguel; Tapolyai, Mihaly; Torosoff, Mikhail T; Dobric, Milan R; Gadkari, Milind Avdhoot; Kyaw, Min Tun; Revivo, Miri; Lustre, Mitchel B; Adel, Mohamed; Hassan, Mohamed; El-Hajjar, Mohammad; Hussain, Mohammed; Saleem, Mohammed; Blanco-Calvo, Moisés; Jiménez-Santos, Moisés; Laukyte, Monika; Saric, Muhamed; Takiuti, Myrthes Emy; Asif, Nadia; Moorthy, Nagaraja; Ogletree, Naima L; Katamadze, Nana O; Nataraj, Nandita; Uchida, Naomi; Ismail, Nasrul; Oliveira, Natalia S; de Carvalho Maffei, Natalia; Brosens, Nathalie; Aslam, Naved; Akhtar, Naveed; Mowafy, Neamat; Pandit, Neeraj; Parakh, Neeraj; Pannu, Neesh; Duncan, Neill; Garcevic, Nevena; Meadows, Ngaire; Danchin, Nicholas; Deming, Nicole; Boskovic, Nikola N; Karogiannis, Nikolaos; Zhang, Ning; Kumar, Nirmal; Sharma, Niruta; Chadha, Nitika; Naik, Nitish; Durfee, Noelle M; Cosgrove, Nora M; Urbanski, Norbert; Hogg, Norma; Walesiak, Olga; ZdoÅ„czyk, Olga; Zhdanova, Olga; Anaya, Olivia; Bello, Olugbenga; Almousalli, Omar; Thompson, Omar; Kliuk, Orit; Méndiz, Oscar; Prada-Delgado, Óscar; Shapira, Oz; Raffaele, Pablo; Salanger, Page; Maurovich-Horvat, Pal; Garg, Pallav; Moraga, Paloma; Singh, Pam; Ouyang, Pamela; Woodard, Pamela; Poggio Smanio, Paola Emanuela; Smanio, Paola; Calabro, Paolo; Nguyen, Patricia K; Alarie, Patricia; Carrilho, Patricia; Endsley, Patricia; Pellikka, Patricia; Lebioda, Patrycja; Der Mesropian, Paul; Hauptman, Paul; GarcÃa-González, Paula; Wilson, Paula; Cury Rezende, Paulo; Novis Rocha, Paulo; Canas Silva, Pedro; Farto E Abreu, Pedro; PÃccaro de Oliveira, Pedro; Carvalho, Pedro; Modas, Pedro; Rio, Pedro; He, Peiyu; McCullough, Peter A; Stone, Peter H; Douglass, Peter; Sizeland, Peter; Voros, Peter; Steg, Philippe Gabriel; Genereux, Philippe; Généreux, Philippe; Menasche, Philippe; Rheault, Philippe; Tassinario, Piero; Gervais, Pierre; Calvillo, Pilar; Chai, Ping; Jakubowski, Piotr; Pruszczyk, Piotr; Loh, Poay-Huan; Samadi, Pouneh; Deedwania, Prakash; Patel, Pranav M; Polamuri, Praneeth; Sharma, Pratiksha; Kamath, Preeti; Thomas, Prince; Arambam, Priyadarshani; Sodhi, Puneet; Naik, Pushpa; Zhong, Qi; Zhao, Qian; Yuan, Qianqian; Xie, Qiulan; Murphy, Rachel; Lyubarova, Radmila; Lyubarova, Radmilar; Fisher, Raewyn; Diaz, Rafael; Maldonado, Rafael; Selgas, Rafael; Bugiardini, Raffaele; Chaudhry, Rafia; Kavalakkat, Raisa; Vs, Rajalekshmi; Nair, Rajesh Gopalan; Narang, Rajiv; Yadav, Rakesh; Carvalho, Ramiro; Jesús-Pérez, Ramon de; Leng, Ran; Kachru, Ranjan; Sanchez, Raquel; Dwyer, Raven R; Lee, Raven; Wyman, Ray; Wong, Raymond C; Hampson, Reinette; Karam Kalil, Renato Abdala; Lopes, Renato D; Eick, Renato George; Lopes, Renato; Ravindran, Reshma; Gamma, Reto Andreas; Costa, Ricardo; Bhatt, Richa; Trimlett, Richard H J; Patel, Risha; Coram, Rita; Riezebos, Robert K; Donnino, Robert M; Guyton, Robert; Harrington, Robert; Malecki, Robert; Favaloro, Roberto René; Elliott, Robyn; Lima, Rodolfo G S D; Tandon, Rohit; Doerr, Rolf; Tewari, Roma; Wald, Ron; Hu, Rongrong; Collins, Rory; Mehran, Roxana; Senior, Roxy; Baleón-Espinosa, Rubén; Ramos, Ruben; Ferreira, Rui; Kirby, Ruth; Pérez-Fernández, Ruth; Ramakrishnan, S; Dwivedi, S K; Lubna, Sadath; Ahmed, Sadiq; Govindan, Sajeev Chakanalil; Alfalahi, Salamah; Cruz-Flores, Salvador; Costa, Salvatore P; Setty, Sampoornima; Nwosu, Samuel; Mahajan, Sandeep; Seth, Sandeep; Singh, Sandeep; Niehe, Sander R; Carr, Sandy; Ogrizovic, Sanja Simic; Ogrizovic, Sanja; Gulati, Sanjeev; Sharma, Sanjeev; Fernandez, Sara; Williams, Sarah; Ralhan, Sarju; Kedev, Sasko; Singh, Satinder; Sankaranarayanan, Satish; Manjunath, Satvic Cholenahally; Lee, Sau; Thaxton, Schawana; O'Brien, Sean M; Sobczak, Sebastian; Nour, Seema; Sayganov, Sergey A; Bravo Baptista, Sérgio; Draibe, Sergio; Sokol, Seth; Chandra, Sharad; Mackedanz, Shari; Goodman, Shaun; Shirazian, Shayan; Karwa, Sheetal Rupesh; Ussery, Sheri; Bajaj, Sheromani; Heydari, Shirin; Choudhary, Shiv Kumar; Patel, Shivali; Pandey, Shruti; Zhang, Shuyang; Gadage, Siddharth; Tan, Sik-Yin V; Poletti, SÃlvia Zottis; Valbuena, Silvia; Savaris, Simone; Yakubov, Solomon; Zhu, Songlin; Gupta, Sonika; Brener, Sorin; Gurunathan, Sothinathan; Nayak, Soundarya; Reddy, Sowjanya; Cobos, Stanley E; Weikl, Stefan; Lane, Stephanie M; Ferket, Stephanie; Mavromichalis, Stephanie; Fremes, Stephen; Fein, Steven A; Sedlis, Steven P; Giovannone, Steven; Weitz, Steven; Banerjee, Subhash; Hegde, Sudhanva S; Hosino, Suellen; Mookherjee, Sulagna; Singh, Suman; Abeygunasekara, Sumith; Mishra, Sundeep; Verma, Sunil Kumar; Kumar, Suresh; Narayanappa, Suryaprakash; Milbrandt, Susan K; Silva, Susana; Stevens, Susanna; Kolhe, Suvarna; Tavares, Suzana; Welsh, Suzanne; Kishore, T A; Colaiácovo Soares, Tamara; Pillay, Tapan Umesh; Rashid, Tarek; Mittal, Tarun K; Duarte, Tauane Bello; Dutoiu, Téodora; Delgadillo, Teresa; Chua, Terrance; Welch, Terrance; Kofidis, Theodoros; Lefevre, Thierry; Silva, Tiago; Boros, Timea; Lau, Titus; Formisano, Tiziana; Ciurus, Tomasz; Tarchalski, Tomasz; Tan, Tracy; Lingaraj, Umesh; Bahl, V K; Narain, V S; Pellu, Valentina; Lobo, Valentine; Robesyn, Valerie; Yadav, Vandana; Gupta, Veerabhadra; Mathew, Verghese; Miro, Vicente; Gumerova, Victoria; Hernandez, Victoria; Kher, Vijay; Kumar, Vijay; Makkar, Vikas; Reddy, Vikranth; Bulkley, Viktoria; David, Vinoi George; Misra, Virendra; Fernández-Figares, Virginia; Ryasniansky, Vladimir; Giga, Vojislav L; Almahmeed, Wael A; Chan, Wan Xian; Marfori, Wanda C; Parker, Wanda; Pennachi, Wayne; Lau, Wei Ling; Xing, Weibing; Bian, Weijing; Stewart, Wendy L; Drewes, Wendy; Hueb, Whady; Weintraub, William; Sia, Winnie C; Flores-RÃos, Xacobe; Ma, Xiang; Gu, Xiangqiong; Li, Xiaomei; Xu, Xiaoyi; Fu, Xin; Li, Xuemei; Wang, Xutong; Pépin-Dubois, Yanek; Arbel, Yaron; Han, Yechen; Lit, Yiming; Sia, Ying Tung; Wang, Ying; Yang, Yining; Ma, Yitong; Peralta, Yolayfi; Smets, Yves; Taul, Yvonne; Kudzoeva, Zalina; Markovic, Zeljko Z; Liu, Zhangsuo; Liu, Zhenyu; Ye, Zhiming; Yu, Zixiang; Davidovits, Zoltan; Petronijevic, Zvezdana
BACKGROUND:Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS:We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS:At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P = 0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P = 0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P = 0.03). CONCLUSIONS:Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.).
PMID: 32227756
ISSN: 1533-4406
CID: 5451232
Health-Status Outcomes with Invasive or Conservative Care in Coronary Disease
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Schnittger, Ingela; Karimullah, Iqbal; Dauber, Ira M; Rehman, Iram; Peovska Mitevska, Irena; Marthe Lang, Irene; Subbotina, Irina; Kalibataite-Rutkauskiene, Irma; Yusnida, Irni; Carvajal, Isabel Estela; Palazzo, Isabella C; Hogan, Isabelle; Roy, Isabelle; Syed, Ishba; Tejani, Ishita; Naryshkin, Ivan A; Jankovic, Ivana; Niedzwiecka, Iwona; Knight, J David; Kusmierek, Jacek; White, Jackie M; Chow, Jackie; Udell, Jacob; Tamis-Holland, Jacqueline E; Fannon, Jacqueline; Quin, Jacquelyn A; Do, Jacquelyn; Heo, Jaekyeong; Maksym, Jakub; Davies, James E; O'Keefe, James H Jr; Jang, James J; Cha, James; Harrison, James; Hirsch, James; Stafford, James; Tatoulis, James; Rankin, Jamie; Henzel, Jan; Orga, Jan; Tancredi, Jana; Oliveira, Janaina; Burton, Jane; Eckstein, Jane; Marucci, Jane; Knight, Janet P; Blount, Janet; Halliday, Janet; Kourzenkova, Janetta; Raj, Janitha; Sinning, Jan-Malte; Pozzibon, Jaqueline; Drozdz, Jaroslaw; Karwowski, Jaroslaw; Glover, Jason D; Kwok, Jason Loh; Call, Jason T; Linefsky, Jason; Gomes, Jassira; Anumpa, Jati; Garcia, Javier J; Courtis, Javier; Meisner, Jay; Jayakumar, K; Scales, Jayne; Denaro, Jean E; Juliard, Jean Michel; Ho, Jean; Stansborough, Jeanette K; Juliard, Jean-Michel; Russo, Jeanne; Schoep, Jeannette J M; Thambyrajah, Jeet; Leimberger, Jeff; Breall, Jeffery A; Kohn, Jeffrey A; Milliken, Jeffrey C; Anderson, Jeffrey; Blume, Jeffrey; Kanters, Jeffrey; Lorin, Jeffrey; Moses, Jeffrey; Stepanovic, Jelena J; Celutkiene, Jelena; Djokic, Jelena; Stojkovic, Jelena; Jose, Jenne M; Manchery, Jenne; Mull, Jennifer A; Czerniak, Jennifer H; Stanford, Jennifer L; Gillis, Jennifer; Horst, Jennifer; Isaacs, Jennifer; Langdon, Jennifer; Thomson, Jennifer; Tomfohr, Jennifer; White, Jennifer; Kuo, Jen-Yuan; Rautureau, Jeremy; Fleg, Jerome; Berg, Jessica; Rodriguez, Jessica; Waldron, Jessica; Patro, Jhina; Li, Jia; Mao, Jiajia; Liu, Jiamin; Wang, Jian'an; Li, Jianhua; Zhang, Jianxin; Qi, Jie; Lyo, Jihyun; Marcus, Jill; Blankenship, Jim; Zhang, Jing; Liu, Jingjing; Fan, Jing-Yao; Li, Jiun-Yi; Pradhan, Jiwan; Chen, Jiyan; Rivera Caravaca, J M; Evans, Jo; Garcia Picart, Joan; Hecht, Joan; Jaroch, Joanna; Zalewska, Joanna; Kelly, Joanne; Taaffe, Joanne; Abbud, João Reynaldo; Vitola, João V; Peñafiel, JoaquÃn V; Benatar, Jocelyne; Bindeman, Jody; Sabik, Joe; Klitch, Joel; Christopher, Johann; Aspberg, Johannes; Friedman, John D; Beltrame, John F; Heitner, John F; Graham, John Joseph; Davies, John R; Doan, John; Kotter, John; Kurian, John; Mukai, John; Pownall, John; Sobolewska, Jolanta; Kobashigawa, Jon; Goldberg, Jonathan L; Bazeley, Jonathan W; Byrne, Jonathan; Himmelfarb, Jonathan; Leipsic, Jonathan; Thorsen, Jonean; Trejo Gutierrez, Jorge F; Escobedo, Jorge; Timmer, Jorik; Ortega-RamÃrez, José A; Marin-Neto, José Antonio; Salas, Jose D; Castillo, Jose Enrique; Saraiva, Jose Francisco; Cuenca-Castillo, José J; Diez, Jose L; Narro Villanueva, José Luis; da Vieira, José Luiz; Flores-Palacios, José M; Gonzalez, Jose Ramon; Seijas Amigo, Jose; Fragata, Jose; Padró, Josep Maria; McGarvey, Josheph F X Jr; Hannan, Joseph; Sacco, Joseph; Sweeny, Joseph; Wiesel, Joseph; Abraham, Josephine D; Loh, Joshua P; Burkhardt, Joy; White, Joyce R; Riestenberg-Smith, Joyce; Sebo, Judit; Meadows, Judith L; Wright, Judith; Foltz, Judy Mae; Hung, Judy; Otis, Judy; Stumpf, Juergen; Tsai, Jui-Peng; Dionne, Julia S; de Aveiro Morata, Julia; Bunke, Julie; Morrow, Julie; Figal, Julio César; Fujita, Jun; Jiang, Jun; Li, Junhua; Yang, Junqing; Euathrongchit, Juntima; Garg, Jyotsna; Manjula Rani, K; Preethi, K; Goetschalckx, Kaatje; Eggers, Kai; Surineni, Kamalakar; Hirase, Kanae; Kapilamoorthy, T R; Calfas, Karen; Gratrix, Karen; Hallett, Karen; Hultberg, Karen; Nugent, Karen; Petrosyan, Karen; Swan, Karen; Kryczka, Karolina; Wojtczak-Soska, Karolina; Wojtera, Karolina; Lenk, Karsten; Ramasamy, Karthik; Åuczak, Katarzyna; Malinowska, Katarzyna; Pointon, Kate; Robb, Kate; Martin, Katherine; Claes, Kathleen; Carruthers, Kathryn; Siegel, Kathy E; Drouin, Katia; Fowler-Lehman, Katie; Rawat, Kavita; Rowe, Kay; Fukuda, Keiichi; Fox, Keith A A; Mahaffey, Ken; Unterbrink, Kendra; Giedd, Kenneth; Van Loo, Kerrie; Lee, Kerry; Bonin, Kerstin; Bainey, Kevin R; Harley, Kevin T; Anstrom, Kevin; Chan, Kevin; Croce, Kevin; Landolfo, Kevin; Marzo, Kevin; Patel, Keyur; Abdul-Nour, Khaled; Alfakih, Khaled; Dajani, Khaled; Ziada, Khaled; Baloch, Khaula; Kushniriuk, Khrystyna; Poh, Kian-Keong; Ireland, Kim F; Holland, Kim; Byrne, Kimberly Ann; Halverson, Kimberly E; Elmore, Kimberly; Miller-Cox, Kimberly; Reddy, Kiran; Quiles, Kirsten J; Abercrombie, Kirsty; Matschke, Klaus; Szymczyk, Konrad; Chan, Koo Hui; Preethi, Kotiboinna; Sokhon, Kozhaya; Meemuk, Krissada; Thygesen, Kristian; Salmi, Kristin M; Newby, Kristin; Wippler, Kristina; Arges, Kristine; Teoh, Kristine; Etherington, Krystal; Åoboz-GrudzieÅ„, Krystyna; Reczuch, Krzysztof W; Bury, Krzysztof; Drzymalski, Krzysztof; KukuÅ‚a, Krzysztof; Sung, Kuo-Tzu; Huber, Kurt; Douangvila, Ladda; Sullenberger, Lance; Trama, Larissa Miranda; Matics, Laszlone; Drew, Laura; Flint, Laura; Keinaite, Laura; Sarti, Laura; Kolakaluri, Laurel; Phillips, Lawrence M; Friedman, Lawrence; Phillips, Lawrence; Velicki, Lazar; Howell, Leah; Maranan, Leandro C; Cox, Leanne; Daba, Ledjalem; Zhang, Lei; Dharmarajan, Lekshmi; Bockeria, Leo; Pizzol Caetano, Leonardo; Bridi, Leonardo; Bershtein, Leonid L; Sokalski, Leszek; Yan, Li Hai; Li, Li; Nijmeijer, Lia; Sousa, Lidia; Xu, Lihong; Zhang, Lihua; Zhang, Lili; Schiavi, Lilia; Barbosa, Lilian Mazza; Khor, Lillian L; Felix-Stern, Lina; Hall, Linda L; Hollenweger, Linda M; Arcand, Linda; Davidson-Ray, Linda; Schwarz, Linda; Sikora, Lindsey N; Chi, Lingping; Patricio, Lino; Zhang, Liping; Chaytor, Lisa; Hatch, Lisa; McCloy, Lisa; Wong, Lisa; Persson, Liselotte; Jiang, Lixin; Low, Liz; Pupic, Ljiljana; Bière, Loïc; Monti, Lorenzo; Christensen, Lori; Pritchard, Lori; Black, Loriane; Desimone, Lori-Ann; Larmand, Lori-Ann; McGregor, Lorraine; Morby, Louise; Thomson, Louise; Harvey, Luc; de Pádua Baptista, Luciana; Garcia, Lucilla; Eliahou, Ludivine; Helmer, Ludmila; Smidt, Luis F; Bernanrdes, Luis; Guzman, Luis; Carvalho, Luiz A; Xiong, Luyang; Teo, Lynette L; Neeson, Lynn M; Winstanley, Lynne; Srichai-Parsia, M Barbara; Quintana Giner, M; Sowjanya Reddy, M; Valdés Chávarri, M; Grazia Rossi, M; Simoons, Maarten; Konigstein, Maayan; Lesiak, Maciej; Olsowka, Maciej; Selas, Mafalda; Corfias, Magalie; Madero Rovalo, Magdalena; Åanocha, Magdalena; Miller, Magdalena; Misztal-Teodorczyk, Magdalena; Rantinella, Magdalena; Abdelhamid, Magdy; Jimenez, Magnolia; Alam, Mahboob; Mylarappa, Mahevamma; El Shahawy, Mahfouz; Mohamed, Mahmoud; Al-Bustami, Mahmud; Joseph, Majo X; Frach, Malgorzata; CeliÅ„ska-Spodar, MaÅ‚gorzta; Helm, Malte; Chacko, Manas; Murphy, Mandy; Vinod, Manitha; Rani, Manjula; Dhawan, Manu; Mombelli, Manuela; Weber, Marcel; Galvani, Marcello; Rodrigues, Marcelo Jamus; Dubin, Marcia F; Werner Bayer, Marcia F; Szkopiak, Marcin; Monsalve, Marco Antonio; Santos, Marco Bizzaro; Magnoni, Marco; Marini, Marco; Sicuro, Marco; Zenati, Marco; Coimbra Resende, Marcos Valério; Roik, Marek; Bentzvi, Margalit; Gilsenan, Margaret; Iraola, Margaret; Quinn, Margot C; Alfonso, Maria A; Pereira Moraes, Maria Antonieta; MartÃnez-RuÃz, MarÃa Dolores; Canales, MarÃa Fernanda; Caetano, Maria Inês; Corral, Maria P; Pérez GarcÃa, Maria; Actis, Maria Victoria; Aguirre, Maria; Andreasson, Maria; Aprile, Maria; Colton, Maria; Martin, Maria Eugenia; Lasala, Maria; Lorenzo, Maria; Posada, Maria; Shier, Maria; Thottam, Maria; Furtado, Mariana V; Okada, Mariana Yumi; Dracoulakis, Marianna D A; De Andrade, Marianne; Rubio, Mariano; Essermark, Marie; Scherrer-Crosbie, Marielle; Petrovic, Marija T; Zdravkovic, Marija; Black, Marilyn; Garcia, Marina; Garcia, Mario J; Szulik, Mariola; Orgera, Marisa; de Belder, Mark A; Harbinson, Mark; Hyun, Mark; Peterson, Mark; Xavier, Mark; Mosley, Marlowe; Capinha, Marta; Marcinkiewicz-Siemion, Marta; Swiderek, Marta; Meyer, Martha; Ceseri, Martina; Tricoli, Martina; Kronenberg, Marvin; Williams, Mary; Champagne, Mary Ann; Rogge, Mary Colleen; Soltau, Mary R; Streif, Mary; Villella, Massimo; Leesar, Massoud; Claudia, Matei; Solecki, Mateusz; Mungo, MatÃas Nicolás; Wall, Matthew Jr; Budoff, Matthew; Jezior, Matthew; Luckie, Matthew; Friedrich, Matthias; Haeffner, Mauren P; Tscharre, Maximilian; Winter, Max-Paul; Almeida, Mayana; Krishnam, Mayil S; Patel, Mayuri; Mishra, Meenakshi; Manocchia, Megan; Kakade, Meghana; Munro, Melanie J; Chaplin, Melissa D; LeFevre, Melissa; Andiapen, Mervyn; Gibson, Michael A; Rubens, Michael B; Turner, Michael C; Shapiro, Michael D; Lee, Michael W; Berlowitz, Michael; Davidson, Michael; Mack, Michael; McDaniel, Michael; Mumma, Michael; Wlodarczyk, Michal; Khouri, Michel G; Slama, Michel S; Rawlins, Michele; Bonner, Michelle M; Seib, Michelle M; Chang, Michelle; Crowder, Michelle; Dixon, Michelle; Mayon, Michelle; McEvoy, Michelle; Yee, Michelle; Fernandes, Miguel M; Nobre Menezes, Miguel; Souto Bayarri, Miguel; Barrero, Miguel; Torosoff, Mikhail T; Dobric, Milan R; Dobric, Milan; Dekleva, Milica Nikola; Gadkari, Milind Avdhoot; Gomez, Millie; Kyaw, Min Tun; Brooks, Miriam; Stevo Martinovic, Miroslav; Lustre, Mitchel B; Vakani, Mohammad Tariq; El-Hajjar, Mohammad; Al-Amoodi, Mohammed; Hussain, Mohammed; Saleem, Mohammed; Blanco-Calvo, Moisés; Jiménez-Santos, Moisés; Bhatia, Mona; Rosca, Monica; Laukyte, Monika; Gracida Blanca, Montserrat; Vila Perales, Montserrat; Al-Mallah, Mouaz H; de Oliveira Filho, Moysés; Ntsekhe, Mpiko; Saric, Muhamed; Chen, Mulei; Brousseau, Myriam; Takiuti, Myrthes Emy; Cemerlic-Adjic, Nada; Asif, Nadia; Gakou, Nadia; Hussain, Nafisa; Katamadze, Nana O; Clapp, Nancy L; Aedy, Nancy; Nataraj, Nandita; Wenger, Nanette K; Uchida, Naomi; Ismail, Nasrul; Oliveira, Natalia S; de Carvalho Maffei, Natalia; Spitzer, Natalie; Putnam, Natasha C; Aslam, Naved; Mowafy, Neamat; Pandit, Neeraj; Parakh, Neeraj; Garcevic, Nevena; Meadows, Ngaire; Tran, Nhi N; Danchin, Nicholas; Lakeman, Nicki; Johnston, Nicola; Shammas, Nicolas W; Saint Vrestil, Nicole; Deming, Nicole; Zhong, Nier; Patel, Niket; Boskovic, Nikola N; Karogiannis, Nikolaos; Werner, Nikos; Johnston, Nina; Zhang, Ning; Zhou, Ning; Hindoyan, Niree; Kumar, Nirmal; Chadha, Nitika; Naik, Nitish; Aripova, Nodira; Mtana, Noloyiso; Eskelson, Nona A; Mokhtar, Noor Syamira; Taksaudom, Noppon; Basri, Nor Asiah; Marchelletta, Nora; Hogg, Norma; Jungla, Nungshi; Ferreira, Nuno; Lubyanaya, Oksana A; Nikolaeva, Olga B; Cañavate, Olga; Sobrino, Olga; Walesiak, Olga; Walter, Olga; ZdoÅ„czyk, Olga; Lim, Olivia J; Anaya, Olivia; Mancilla, Olivia; Dubourg, Olivier; Bello, Olugbenga; Almousalli, Omar; Thompson, Omar; Olurinde, Oni; Harel, Or; Raheem, Osama; Méndiz, Oscar; Prada-Delgado, Óscar; Shapira, Oz; Schulze, P Christian; Panpunuan, Pachara; Maurovich-Horvat, Pal; Garg, Pallav; Moraga, Paloma; Singh, Pam; Julian, Pamela; Ouyang, Pamela; Sigel, Pamela; Woodard, Pamela; Zhou, Panpan; Poggio, Paola Emanuela; Smanio, Paola; Calabro, Paolo; Jeetley, Paramjit; Goube, Pascal; Nguyen, Patricia K; Alarie, Patricia; Arakelian, Patricia; Arsenault, Patricia; Blaise, Patricia; Brito, Patricia; Cowper, Patricia; Endsley, Patricia; Mieses, Patricia; Alexander, Patrick B; Donnelly, Patrick; Wilmot, Patrick; Lebioda, Patrycja; Gordon, Paul C; Mesropian, Paul Der; Galiwango, Paul; Hauptman, Paul; Kennedy, Paul; Beardsley, Paula; GarcÃa-González, Paula; Rezende, Paulo Cury; Caramori, Paulo Ricardo; Kozlov, Pavel S; Canas Silva, Pedro; Melo Barros E Silva, Pedro Gabriel; PÃccaro de Oliveira, Pedro; Carvalho, Pedro; Modas, Pedro; Rio, Pedro; Jain, Peeyush; He, Peiyu; McCullough, Peter A; Stone, Peter H; Pollak, Peter M; Douglass, Peter; Henriksen, Peter; OKane, Peter; Ong, Peter; Jones, Philip; Rogal, Philip; Généreux, Philippe; Menasche, Philippe; Rheault, Philippe; Goold, Phoebe; Gervais, Pierre; Michaud, Pierre; Calvillo, Pilar; Chai, Ping; Jakubowski, Piotr; Pruszczyk, Piotr; Slomka, Piotr; Sritara, Piyamitr; Loh, Poay-Huan; Sonawane, Poonam; Samadi, Pouneh; Parikh, Pragnesh P; Deedwania, Prakash; Patel, Pranav M; Polamuri, Praneeth; Sharma, Pratiksha; Vasquez, Precilia; Kamath, Preeti; Thomas, Prince; Arambam, Priyadarshani; Mehta, Puja K; Grant, Purvez; Naik, Pushpa; Zhong, Qi; Zhao, Qian; Zhou, Qiang; Yuan, Qianqian; Yu, Qin; Li, Qingxian; Xie, Qiulan; Zeng, Qiutang; Vindhya, R J; Gerlach, R James; King, Rachel; VuÄić, Rada; Lyubarova, Radmila; Pracon, Radoslaw; Fisher, Raewyn; Beyar, Rafael; Diaz, Rafael; Selgas, Rafael; Bugiardini, Raffaele; Fanelli, Raffaele; Kavalakkat, Raisa; Rajalekshmi, V S; Barua, Rajat S; Menon, Rajeev; Nair, Rajesh Gopalan; Francis, Rajesh; Narang, Rajiv; Yadav, Rakesh; Huston, Ralph Alan; Ramakrishnan, T; de Silva, Ramesh; Mahmoud, Rami El; Carvalho, Ramiro; de Jesús-Pérez, Ramon; Stevens, Ramona; Leng, Ran; Kachru, Ranjan; Nath, Ranjit Kumar; Sanchez, Raquel; Dwyer, Raven R; Lee, Raven; Wyman, Ray; Wong, Raymond C; Little, Raymond W; Ocaranza Sanchez, Raymundo; Wimmer, Rebecca J; Bariciano, Rebecca; Otis, Rebecca; Herrmann, Rebekah R; Yunis, Reem; Hampson, Reinette; Karam, Renato Abdala; Hessian, Renee C; Kaneshiro, Renee; Ravindran, Reshma; Gamma, Reto Andreas; Bhandari, Reyna; Arsanjani, Reza; Lopes, Ricardo L; Mendes Oliveira, Ricardo; Costa, Ricardo; Bhatt, Richa; Davies, Richard F; Trimlett, Richard H J; Goldweit, Richard; Hermanides, Rik; Nakanishi, Rine; Sidh, Rinu R; Patel, Risha; Coram, Rita; Siddiqui, Rizwan A; Beanlands, Rob S; Hamburger, Robert J; Riezebos, Robert K; Donnino, Robert M; Bojar, Robert; Chilton, Robert; Guyton, Robert; Henderson, Robert; Kornberg, Robert; Leber, Robert; Mao, Robert; Stenberg, Robert; Santos, Roberta P; Favaloro, Roberto René; Amati, Roberto; Lima, Rodolfo G S D; Cerci, Rodrigo J; Tumelero, Rogerio; Tandon, Rohit; Tewari, Roma; Miranda-Peats, Romalisa; Wald, Ron; Mastouri, Ronald A; Morford, Ronald G; Schwartz, Ronald G; Pedalino, Ronald P; Hu, Rongrong; Hansen, Ronnell A; Cohen, Ronny A; Hachamovitch, Rory; Homem, Rosa; Sandonato, Rosa; Laimer, Rosane; Gans, Rosann; Yost, Roxanne; Mathew, Roy; Baleón-Espinosa, Rubén; Ramos, Ruben; Gevorgyan, Rubine; Ferreira, Rui; Jing, Rui; Pérez-Fernández, Ruth; Dwivedi, S K; Ramakrishnan, S; Khan, Saadat; Bokhari, Sabahat; Thomas, Sabu; Lubna, Sadath; Khan, Sajeeda Parveen; Govindan, Sajeev Chakanalil; Girotra, Saket; Kassam, Saleem; Canada, Sallie; Cruz-Flores, Salvador; Mohamed, Samaa; Ly, Samantha; El Kaffas, Sameh; Massalha, Samia; Setty, Sampoornima; Nwosu, Samuel; Seth, Sandeep; Singh, Sandeep; Niehe, Sander R; Rivest, Sandra M; Zier, Sandra S; Ahoud, Sandra; Carr, Sandy; Ganapathi, Sanjay; Shetty, Sanjay; Sharma, Sanjeev; Jimenez, Santa; Satheesh, Santhosh; Garcia, Santiago A; Fernandez, Sara; Karlsson, Sara; Salkind, Sara; Temiyasathit, Sara; Medina Rodriguez, Sarah; Beaudry, Sarah; Hadjih, Sarah; Williams, Sarah; Zahrani, Sarah; Ralhan, Sarju; Hinic, Sasa; Kedev, Sasko; Singh, Satinder; Yasuda, Satoshi; Manjunath, Satvic Cholenahally; Lee, Sau; Kaczkowski, Scott M; Kinlay, Scott; Hayes, Sean W; Sobczak, Sebastian; Asier, Senait; Sayganov, Sergey A; Sokol, Seth I; Pandie, Shaheen; Yahaya, Shaiful Azmi; Mehta, Shamir; Nie, Shao-Ping; Chandra, Sharad; Islam, Sharder; Tai, Sharon; Karwa, Sheetal Rupesh; Ussery, Sheri; Bajaj, Sheromani; Crook, Sherron C; Nishimura, Shigeyuki; Nakano, Shintaro; Heydari, Shirin; Choudhary, Shiv Kumar; Patel, Shivali; Ganesan, Shobana; Pandey, Shruti; Zhang, Shuyang; Hande, Shweta; Gadage, Siddharth; Tan, Sik-Yin V; Zottis Poletti, Silvia; Riera, Silvia; Valbuena, Silvia; Walsh, Simon; Maspoli, Simona; Savaris, Simone; Feng, Si-Ting; Cho, So Yang; Yakubov, Solomon; Zhu, Songlin; Wang, Songtao; Guerrero, Sonia; Gupta, Sonika; Salinger Martinovic, Sonja; Brons, Sonya; Brener, Sorin; Gurunathan, Sothinathan; Saba, Souheil; Nayak, Soundarya; Reddy, Sowjanya; Potluri, Srinivasa; Sudarshan, Sriram; Kuanprasert, Srun; Van Oosterhout, Stacie; Lerakis, Stamatios; Cobos, Stanley E; Bertog, Stefan C; Simović, Stefan M; Weikl, Stefan; Di Marco, Stefano; Provasoli, Stefano; Tirado, Stephanie A; Boer, Stephanie C; Lane, Stephanie M; Ferket, Stephanie; Kelly, Stephanie; Wasmiller, Stephanie; McKellar, Stephen H; Hoole, Stephen P; Fremes, Stephen; Preston, Stephen; Leung, Steve; Fein, Steven A; Lindsay, Steven J; Sedlis, Steven P; Giovannone, Steven; Michael, Steven; Weitz, Steven; van Vugt, Stijn; Banerjee, Subhash; Naik, Sudhir; Hosino, Suellen; Desire, Sukie; Yamwong, Sukit; Thambar, Suku T; Mookherjee, Sulagna; Singh, Suman; Mishra, Sundeep; Verma, Sunil Kumar; Kulthawong, Supap; Khwakhong, Supatchara; Naik, Surendra; Babu, Suresh; Woragidpoonpol, Surin; Narayanappa, Suryaprakash; Derbyshire, Susan; Gent, Susan; Mathus, Susan; Milbrandt, Susan; Moore, Susan; Regan, Susan; Stinson, Susan; Webber, Susan; Silva, Susana; Stevens, Susanna; Gruensfelder, Susanne; Aramcharoen, Suthara; Kolhe, Suvarna; Tavares, Suzana; Arnold, Suzanne; Welsh, Suzanne; Apostolovic, Svetlana; Kunhunny, Swapna; Hung, Ta-Chuan; Zappernick, Taissa; Sharir, Tali; Silva, Talita; Soares, Tamara Colaiácovo; Pillay, Tapan Umesh; Mittal, Tarun K; Trifonova, Tatiana; Duarte, Tauane Bello; Huk, Tauqir; Dutoiu, Téodora; Chua, Terrance; Weyand, Terry; Charles, Thabitha; Kofidis, Theodoros; McCreary, Theresa; Lefevre, Thierry; Arumairajah, Thippeekaa; Tepsuwan, Thitipong; Mulhearn, Thomas J; Meyer, Thomas M; Rocco, Thomas P; Downes, Thomas R; Crain, Thomas; Haldis, Thomas; Mathew, Thomas; Redick, Thomas; Devi, Thounaojam Indira; Nageh, Thuraia; Cauthren, Tia; Silva, Tiago; Little, Tiffany; Andric, Tijana; Harding, Tina; Lau, Titus; Formisano, Tiziana; Moccetti, Tiziano; Ciurus, Tomasz; Mazurek, Tomasz; Tarchalski, Tomasz; Nagai, Toshiyuki; Tran, Tri; Youn, Tricia; Tucker, Trish; Milner, Trudie; Bose, Tuhina; Kotecha, Tushar; Sechtem, Udo; Valeti, Uma S; Cucchini, Umberto; Badami, Umesh; Kaul, Upendra; Bahl, V K; Narain, V S; Casali, Valentina; Godoy, Valeria; Robesyn, Valerie; Priya, Vamshi P; Yadav, Vandana; McKinney, Vera; De Lenges, Veronica; Tinnirello, Veronica; Miro, Vicente; Navarro, Victor; Gumerova, Victoria; Hernandez, Victoria; Seeratan, Vidya; Kumar, Vijay; Kozulin, Vikentiy Y; Bulkley, Viktoria; Veiga, Vilmar Jr; Setang, Vincent; Vineeth, C P; Pubull Nuñez, Virginai; Fernández-Figares, Virginia; Gomes, Vitor; Gabriel, Viviana; Dos Santos, Viviane; Almeida, Viviane; Iliescu, Vlad A; Mudrenovic, Vladan; Dzavik, Vladimir; Giga, Vojislav L; Mogrovejo, Walter Enrique; Chan, Wan Xian; Marfori, Wanda C; Parker, Wanda; Mekara, Warangkana; Nona, Wassim; Old, Wayne; Pennachi, Wayne; Nawarawong, Weerachai; Chen, Wei; Su, Wei; Xing, Weibing; Lan, Wei-Ren; Crawford, Wenda; Stewart, Wendy L; Drewes, Wendy; Lin, Wenhua; Abernethy, William B; Salerno, William D; Fearon, William F; Vergoni, William; Weintraub, William; Sia, Winnie C; Musial, Wlodzimierz J; Flores-RÃos, Xacobe; Garcia-Moll Marimon, Xavier; Su, Xi; Ma, Xiang; Gu, Xiangqiong; Wang, Xiao; Li, Xiaomei; Yao, Xiaowei; Fu, Xin; Su, Xin; Zeng, Xin; Yang, Xinchun; Li, Xiuhong; Fang, Xuehua; Wang, Xutong; Geng, Yaming; Yan, Yan; Pépin-Dubois, Yanek; Wang, Yanfu; Wang, Yang; Tian, Yanmeng; Huang, Yaping; Han, Yechen; Zambrano, Yesenia; Yang, Yi-Hsuan; Sia, Ying Tung; Yang, Yining; Ma, Yitong; Peralta, Yolayfi; Wu, Yongjian; Kunwu, Yu; Zhao, Yu; Peng, Yudong; Lin, Yueh-Hung; Zhao, Yulan; Dong, Yumei; Zhao, Yunhai; Wannasopha, Yutthaphan; Taul, Yvonne; Sahul, Zakir; Kudzoeva, Zalina; Kalarus, Zbigniew; Markovic, Zeljko Z; Huang, Zhen; Ji, Zheng; Liu, Zhenyu; Yue, Zhou; Zhang, Zhulin; Li, Zhuxi; Singh Meharwal, Zile; Bai, Ziliang; Yu, Zixiang; Huda, Zohra; Davidovits, Zoltan
BACKGROUND:In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS:We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS:At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS:In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
PMID: 32227753
ISSN: 1533-4406
CID: 5451262
Initial Invasive or Conservative Strategy for Stable Coronary Disease
Maron, David J; Hochman, Judith S; Reynolds, Harmony R; Bangalore, Sripal; O'Brien, Sean M; Boden, William E; Chaitman, Bernard R; Senior, Roxy; López-Sendón, Jose; Alexander, Karen P; Lopes, Renato D; Shaw, Leslee J; Berger, Jeffrey S; Newman, Jonathan D; Sidhu, Mandeep S; Goodman, Shaun G; Ruzyllo, Witold; Gosselin, Gilbert; Maggioni, Aldo P; White, Harvey D; Bhargava, Balram; Min, James K; Mancini, G B John; Berman, Daniel S; Picard, Michael H; Kwong, Raymond Y; Ali, Ziad A; Mark, Daniel B; Spertus, John A; Krishnan, Mangalath N; Elghamaz, Ahmed; Moorthy, Nagaraja; Hueb, Whady A; Demkow, Marcin; Mavromatis, Kreton; Bockeria, Olga; Peteiro, Jesus; Miller, Todd D; Szwed, Hanna; Doerr, Rolf; Keltai, Matyas; Selvanayagam, Joseph B; Steg, P Gabriel; Held, Claes; Kohsaka, Shun; Mavromichalis, Stavroula; Kirby, Ruth; Jeffries, Neal O; Harrell, Frank E; Rockhold, Frank W; Broderick, Samuel; Ferguson, T Bruce; Williams, David O; Harrington, Robert A; Stone, Gregg W; Rosenberg, Yves; Ricci, Joseph; 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Vila Perales, Montserrat; Al-Mallah, Mouaz H; de Oliveira Filho, Moysés; Ntsekhe, Mpiko; Saric, Muhamed; Chen, Mulei; Brousseau, Myriam; Takiuti, Myrthes Emy; Cemerlic-Adjic, Nada; Asif, Nadia; Gakou, Nadia; Hussain, Nafisa; Katamadze, Nana O; Clapp, Nancy L; Aedy, Nancy; Nataraj, Nandita; Wenger, Nanette K; Uchida, Naomi; Ismail, Nasrul; Oliveira, Natalia S; de Carvalho Maffei, Natalia; Spitzer, Natalie; Putnam, Natasha C; Aslam, Naved; Mowafy, Neamat; Pandit, Neeraj; Parakh, Neeraj; Garcevic, Nevena; Meadows, Ngaire; Tran, Nhi N; Danchin, Nicholas; Lakeman, Nicki; Johnston, Nicola; Shammas, Nicolas W; Saint Vrestil, Nicole; Deming, Nicole; Zhong, Nier; Patel, Niket; Boskovic, Nikola N; Karogiannis, Nikolaos; Werner, Nikos; Johnston, Nina; Zhang, Ning; Zhou, Ning; Hindoyan, Niree; Kumar, Nirmal; Chadha, Nitika; Naik, Nitish; Aripova, Nodira; Mtana, Noloyiso; Eskelson, Nona A; Mokhtar, Noor Syamira; Taksaudom, Noppon; Basri, Nor Asiah; Marchelletta, Nora; Hogg, Norma; Jungla, Nungshi; Ferreira, Nuno; Lubyanaya, Oksana A; Nikolaeva, Olga B; Cañavate, Olga; Sobrino, Olga; Walesiak, Olga; Walter, Olga; ZdoÅ„czyk, Olga; Lim, Olivia J; Anaya, Olivia; Mancilla, Olivia; Dubourg, Olivier; Bello, Olugbenga; Almousalli, Omar; Thompson, Omar; Olurinde, Oni; Harel, Or; Raheem, Osama; Méndiz, Oscar; Prada-Delgado, Óscar; Shapira, Oz; Schulze, P Christian; Panpunuan, Pachara; Maurovich-Horvat, Pal; Garg, Pallav; Moraga, Paloma; Singh, Pam; Julian, Pamela; Ouyang, Pamela; Sigel, Pamela; Woodard, Pamela; Zhou, Panpan; Poggio, Paola Emanuela; Smanio, Paola; Calabro, Paolo; Jeetley, Paramjit; Goube, Pascal; Nguyen, Patricia K; Alarie, Patricia; Arakelian, Patricia; Arsenault, Patricia; Blaise, Patricia; Brito, Patricia; Cowper, Patricia; Endsley, Patricia; Mieses, Patricia; Alexander, Patrick B; Donnelly, Patrick; Wilmot, Patrick; Lebioda, Patrycja; Gordon, Paul C; Mesropian, Paul Der; Galiwango, Paul; Hauptman, Paul; Kennedy, Paul; Beardsley, Paula; GarcÃa-González, Paula; Rezende, Paulo Cury; Caramori, Paulo Ricardo; Kozlov, Pavel S; Canas Silva, Pedro; Melo Barros E Silva, Pedro Gabriel; PÃccaro de Oliveira, Pedro; Carvalho, Pedro; Modas, Pedro; Rio, Pedro; Jain, Peeyush; He, Peiyu; McCullough, Peter A; Stone, Peter H; Pollak, Peter M; Douglass, Peter; Henriksen, Peter; OKane, Peter; Ong, Peter; Jones, Philip; Rogal, Philip; Généreux, Philippe; Menasche, Philippe; Rheault, Philippe; Goold, Phoebe; Gervais, Pierre; Michaud, Pierre; Calvillo, Pilar; Chai, Ping; Jakubowski, Piotr; Pruszczyk, Piotr; Slomka, Piotr; Sritara, Piyamitr; Loh, Poay-Huan; Sonawane, Poonam; Samadi, Pouneh; Parikh, Pragnesh P; Deedwania, Prakash; Patel, Pranav M; Polamuri, Praneeth; Sharma, Pratiksha; Vasquez, Precilia; Kamath, Preeti; Thomas, Prince; Arambam, Priyadarshani; Mehta, Puja K; Grant, Purvez; Naik, Pushpa; Zhong, Qi; Zhao, Qian; Zhou, Qiang; Yuan, Qianqian; Yu, Qin; Li, Qingxian; Xie, Qiulan; Zeng, Qiutang; Vindhya, R J; Gerlach, R James; King, Rachel; VuÄić, Rada; Lyubarova, Radmila; Pracon, Radoslaw; Fisher, Raewyn; Beyar, Rafael; Diaz, Rafael; Selgas, Rafael; Bugiardini, Raffaele; Fanelli, Raffaele; Kavalakkat, Raisa; Rajalekshmi, V S; Barua, Rajat S; Menon, Rajeev; Nair, Rajesh Gopalan; Francis, Rajesh; Narang, Rajiv; Yadav, Rakesh; Huston, Ralph Alan; Ramakrishnan, T; de Silva, Ramesh; Mahmoud, Rami El; Carvalho, Ramiro; de Jesús-Pérez, Ramon; Stevens, Ramona; Leng, Ran; Kachru, Ranjan; Nath, Ranjit Kumar; Sanchez, Raquel; Dwyer, Raven R; Lee, Raven; Wyman, Ray; Wong, Raymond C; Little, Raymond W; Ocaranza Sanchez, Raymundo; Wimmer, Rebecca J; Bariciano, Rebecca; Otis, Rebecca; Herrmann, Rebekah R; Yunis, Reem; Hampson, Reinette; Karam, Renato Abdala; Hessian, Renee C; Kaneshiro, Renee; Ravindran, Reshma; Gamma, Reto Andreas; Bhandari, Reyna; Arsanjani, Reza; Lopes, Ricardo L; Mendes Oliveira, Ricardo; Costa, Ricardo; Bhatt, Richa; Davies, Richard F; Trimlett, Richard H J; Goldweit, Richard; Hermanides, Rik; Nakanishi, Rine; Sidh, Rinu R; Patel, Risha; Coram, Rita; Siddiqui, Rizwan A; 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Setty, Sampoornima; Nwosu, Samuel; Seth, Sandeep; Singh, Sandeep; Niehe, Sander R; Rivest, Sandra M; Zier, Sandra S; Ahoud, Sandra; Carr, Sandy; Ganapathi, Sanjay; Shetty, Sanjay; Sharma, Sanjeev; Jimenez, Santa; Satheesh, Santhosh; Garcia, Santiago A; Fernandez, Sara; Karlsson, Sara; Salkind, Sara; Temiyasathit, Sara; Medina Rodriguez, Sarah; Beaudry, Sarah; Hadjih, Sarah; Williams, Sarah; Zahrani, Sarah; Ralhan, Sarju; Hinic, Sasa; Kedev, Sasko; Singh, Satinder; Yasuda, Satoshi; Manjunath, Satvic Cholenahally; Lee, Sau; Kaczkowski, Scott M; Kinlay, Scott; Hayes, Sean W; Sobczak, Sebastian; Asier, Senait; Sayganov, Sergey A; Sokol, Seth I; Pandie, Shaheen; Yahaya, Shaiful Azmi; Mehta, Shamir; Nie, Shao-Ping; Chandra, Sharad; Islam, Sharder; Tai, Sharon; Karwa, Sheetal Rupesh; Ussery, Sheri; Bajaj, Sheromani; Crook, Sherron C; Nishimura, Shigeyuki; Nakano, Shintaro; Heydari, Shirin; Choudhary, Shiv Kumar; Patel, Shivali; Ganesan, Shobana; Pandey, Shruti; Zhang, Shuyang; Hande, Shweta; Gadage, Siddharth; Tan, Sik-Yin V; Zottis Poletti, Silvia; Riera, Silvia; Valbuena, Silvia; Walsh, Simon; Maspoli, Simona; Savaris, Simone; Feng, Si-Ting; Cho, So Yang; Yakubov, Solomon; Zhu, Songlin; Wang, Songtao; Guerrero, Sonia; Gupta, Sonika; Salinger Martinovic, Sonja; Brons, Sonya; Brener, Sorin; Gurunathan, Sothinathan; Saba, Souheil; Nayak, Soundarya; Reddy, Sowjanya; Potluri, Srinivasa; Sudarshan, Sriram; Kuanprasert, Srun; Van Oosterhout, Stacie; Lerakis, Stamatios; Cobos, Stanley E; Bertog, Stefan C; Simović, Stefan M; Weikl, Stefan; Di Marco, Stefano; Provasoli, Stefano; Tirado, Stephanie A; Boer, Stephanie C; Lane, Stephanie M; Ferket, Stephanie; Kelly, Stephanie; Wasmiller, Stephanie; McKellar, Stephen H; Hoole, Stephen P; Fremes, Stephen; Preston, Stephen; Leung, Steve; Fein, Steven A; Lindsay, Steven J; Sedlis, Steven P; Giovannone, Steven; Michael, Steven; Weitz, Steven; van Vugt, Stijn; Banerjee, Subhash; Naik, Sudhir; Hosino, Suellen; Desire, Sukie; Yamwong, Sukit; 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Ji, Zheng; Liu, Zhenyu; Yue, Zhou; Zhang, Zhulin; Li, Zhuxi; Singh Meharwal, Zile; Bai, Ziliang; Yu, Zixiang; Huda, Zohra; Davidovits, Zoltan
BACKGROUND:Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS:We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS:Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS:Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
PMID: 32227755
ISSN: 1533-4406
CID: 5451242
