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129


Clearing the air to treat hypertension

Newman, Jonathan D; Rajagopalan, Sanjay; Levy, Phillip; Brook, Robert D
PMID: 32439971
ISSN: 1476-5527
CID: 4464642

Myocardial infarction accelerates breast cancer via innate immune reprogramming

Koelwyn, Graeme J; Newman, Alexandra A C; Afonso, Milessa S; van Solingen, Coen; Corr, Emma M; Brown, Emily J; Albers, Kathleen B; Yamaguchi, Naoko; Narke, Deven; Schlegel, Martin; Sharma, Monika; Shanley, Lianne C; Barrett, Tessa J; Rahman, Karishma; Mezzano, Valeria; Fisher, Edward A; Park, David S; Newman, Jonathan D; Quail, Daniela F; Nelson, Erik R; Caan, Bette J; Jones, Lee W; Moore, Kathryn J
Disruption of systemic homeostasis by either chronic or acute stressors, such as obesity1 or surgery2, alters cancer pathogenesis. Patients with cancer, particularly those with breast cancer, can be at increased risk of cardiovascular disease due to treatment toxicity and changes in lifestyle behaviors3-5. While elevated risk and incidence of cardiovascular events in breast cancer is well established, whether such events impact cancer pathogenesis is not known. Here we show that myocardial infarction (MI) accelerates breast cancer outgrowth and cancer-specific mortality in mice and humans. In mouse models of breast cancer, MI epigenetically reprogrammed Ly6Chi monocytes in the bone marrow reservoir to an immunosuppressive phenotype that was maintained at the transcriptional level in monocytes in both the circulation and tumor. In parallel, MI increased circulating Ly6Chi monocyte levels and recruitment to tumors and depletion of these cells abrogated MI-induced tumor growth. Furthermore, patients with early-stage breast cancer who experienced cardiovascular events after cancer diagnosis had increased risk of recurrence and cancer-specific death. These preclinical and clinical results demonstrate that MI induces alterations in systemic homeostasis, triggering cross-disease communication that accelerates breast cancer.
PMID: 32661390
ISSN: 1546-170x
CID: 4528032

COVID-19 and the Heart and Vasculature: Novel Approaches to Reduce Virus-Induced Inflammation in Patients With Cardiovascular Disease

Kadosh, Bernard S; Garshick, Michael S; Gaztanaga, Juan; Moore, Kathryn J; Newman, Jonathan D; Pillinger, Michael; Ramasamy, Ravichandran; Reynolds, Harmony R; Shah, Binita; Hochman, Judith; Fishman, Glenn I; Katz, Stuart D
The coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented challenge and opportunity for translational investigators to rapidly develop safe and effective therapeutic interventions. Greater risk of severe disease in COVID-19 patients with comorbid diabetes mellitus, obesity, and heart disease may be attributable to synergistic activation of vascular inflammation pathways associated with both COVID-19 and cardiometabolic disease. This mechanistic link provides a scientific framework for translational studies of drugs developed for treatment of cardiometabolic disease as novel therapeutic interventions to mitigate inflammation and improve outcomes in patients with COVID-19.
PMID: 32687400
ISSN: 1524-4636
CID: 4551152

Association of Sex With Severity of Coronary Artery Disease, Ischemia, and Symptom Burden in Patients With Moderate or Severe Ischemia: Secondary Analysis of the ISCHEMIA Randomized Clinical Trial

Reynolds, Harmony R; Shaw, Leslee J; Min, James K; Spertus, John A; Chaitman, Bernard R; Berman, Daniel S; Picard, Michael H; Kwong, Raymond Y; Bairey-Merz, C Noel; Cyr, Derek D; Lopes, Renato D; Lopez-Sendon, Jose Luis; Held, Claes; Szwed, Hanna; Senior, Roxy; Gosselin, Gilbert; Nair, Rajesh Gopalan; Elghamaz, Ahmed; Bockeria, Olga; Chen, Jiyan; Chernyavskiy, Alexander M; Bhargava, Balram; Newman, Jonathan D; Hinic, Sasa B; Jaroch, Joanna; Hoye, Angela; Berger, Jeffrey; Boden, William E; O'Brien, Sean M; Maron, David J; Hochman, Judith S
Importance/UNASSIGNED:While many features of stable ischemic heart disease vary by sex, differences in ischemia, coronary anatomy, and symptoms by sex have not been investigated among patients with moderate or severe ischemia. The enrolled ISCHEMIA trial cohort that underwent coronary computed tomographic angiography (CCTA) was required to have obstructive coronary artery disease (CAD) for randomization. Objective/UNASSIGNED:To describe sex differences in stress testing, CCTA findings, and symptoms in ISCHEMIA trial participants. Design, Setting, and Participants/UNASSIGNED:This secondary analysis of the multicenter ISCHEMIA randomized clinical trial analyzed baseline characteristics of patients with stable ischemic heart disease. Individuals were enrolled from July 2012 to January 2018 based on local reading of moderate or severe ischemia on a stress test, after which blinded CCTA was performed in most. Core laboratories reviewed stress tests and CCTAs. Participants with no obstructive CAD or with left main CAD of 50% or greater were excluded. Those who met eligibility criteria including CCTA (if performed) were randomized to a routine invasive or a conservative management strategy (N = 5179). Angina was assessed using the Seattle Angina Questionnaire. Analysis began October 1, 2018. Interventions/UNASSIGNED:CCTA and angina assessment. Main Outcomes and Measures/UNASSIGNED:Sex differences in stress test, CCTA findings, and symptom severity. Results/UNASSIGNED:Of 8518 patients enrolled, 6256 (77%) were men. Women were more likely to have no obstructive CAD (<50% stenosis in all vessels on CCTA) (353 of 1022 [34.4%] vs 378 of 3353 [11.3%]). Of individuals who were randomized, women had more angina at baseline than men (median [interquartile range] Seattle Angina Questionnaire Angina Frequency score: 80 [70-100] vs 90 [70-100]). Women had less severe ischemia on stress imaging (383 of 919 [41.7%] vs 1361 of 2972 [45.9%] with severe ischemia; 386 of 919 [42.0%] vs 1215 of 2972 [40.9%] with moderate ischemia; and 150 of 919 [16.4%] vs 394 of 2972 [13.3%] with mild or no ischemia). Ischemia was similar by sex on exercise tolerance testing. Women had less extensive CAD on CCTA (205 of 568 women [36%] vs 1142 of 2418 men [47%] with 3-vessel disease; 184 of 568 women [32%] vs 754 of 2418 men [31%] with 2-vessel disease; and 178 of 568 women [31%] vs 519 of 2418 men [22%] with 1-vessel disease). Female sex was independently associated with greater angina frequency (odds ratio, 1.41; 95% CI, 1.13-1.76). Conclusions and Relevance/UNASSIGNED:Women in the ISCHEMIA trial had more frequent angina, independent of less extensive CAD, and less severe ischemia than men. These findings reflect inherent sex differences in the complex relationships between angina, atherosclerosis, and ischemia that may have implications for testing and treatment of patients with suspected stable ischemic heart disease. Trial Registration/UNASSIGNED:ClinicalTrials.gov Identifier: NCT01471522.
PMCID:7105951
PMID: 32227128
ISSN: 2380-6591
CID: 4368622

Effects of Home Particulate Air Filtration on Blood Pressure: A Systematic Review

Walzer, Dalia; Gordon, Terry; Thorpe, Lorna; Thurston, George; Xia, Yuhe; Zhong, Hua; Roberts, Timothy R; Hochman, Judith S; Newman, Jonathan D
Air pollution is a major contributor to cardiovascular morbidity and mortality. Fine particulate matter <2.5 µm in diameter may be a modifiable risk factor for hypertension. The benefits of in-home air filtration on systolic blood pressure (BP) and diastolic BP are unclear. To examine the effects of in-home personal air cleaner use on fine particulate exposure and BP, we queried PubMed, Web of Science, Cochrane Central Register, Inspec, and EBSCO GreenFILE databases for relevant clinical trials. Included studies were limited to nonsmoking participants in smoke-free homes with active or sham filtration on indoor fine particulate concentrations and changes in systolic and diastolic BP. Of 330 articles identified, 10 trials enrolling 604 participants who met inclusion criteria were considered. Over a median 13.5 days, there was a significant reduction of mean systolic BP by ≈4 mm Hg (-3.94 mm Hg [95% CI, -7.00 to -0.89]; P=0.01) but a nonsignificant difference in mean diastolic BP (-0.95 mm Hg [95% CI, -2.81 to 0.91]; P=0.32). Subgroup analyses indicated no heterogeneity of effect by age, level of particulate exposure, or study duration. Given the variation in study design, additional study is warranted to confirm and better quantify the observed benefits in systolic BP found with personal air cleaner use.
PMCID:7289680
PMID: 32475316
ISSN: 1524-4563
CID: 4476662

Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19

Reynolds, Harmony R; Adhikari, Samrachana; Pulgarin, Claudia; Troxel, Andrea B; Iturrate, Eduardo; Johnson, Stephen B; Hausvater, Anaïs; Newman, Jonathan D; Berger, Jeffrey S; Bangalore, Sripal; Katz, Stuart D; Fishman, Glenn I; Kunichoff, Dennis; Chen, Yu; Ogedegbe, Gbenga; Hochman, Judith S
BACKGROUND:There is concern about the potential of an increased risk related to medications that act on the renin-angiotensin-aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2). METHODS:We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference. RESULTS:Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive. CONCLUSIONS:We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications.
PMID: 32356628
ISSN: 1533-4406
CID: 4412912

Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association

Arnold, Suzanne V; Bhatt, Deepak L; Barsness, Gregory W; Beatty, Alexis L; Deedwania, Prakash C; Inzucchi, Silvio E; Kosiborod, Mikhail; Leiter, Lawrence A; Lipska, Kasia J; Newman, Jonathan D; Welty, Francine K
Although cardiologists have long treated patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (T2DM), T2DM has traditionally been considered just a comorbidity that affected the development and progression of the disease. Over the past decade, a number of factors have shifted that have forced the cardiology community to reconsider the role of T2DM in CAD. First, in addition to being associated with increased cardiovascular risk, T2DM has the potential to affect a number of treatment choices for CAD. In this document, we discuss the role that T2DM has in the selection of testing for CAD, in medical management (both secondary prevention strategies and treatment of stable angina), and in the selection of revascularization strategy. Second, although glycemic control has been recommended as a part of comprehensive risk factor management in patients with CAD, there is mounting evidence that the mechanism by which glucose is managed can have a substantial impact on cardiovascular outcomes. In this document, we discuss the role of glycemic management (both in intensity of control and choice of medications) in cardiovascular outcomes. It is becoming clear that the cardiologist needs both to consider T2DM in cardiovascular treatment decisions and potentially to help guide the selection of glucose-lowering medications. Our statement provides a comprehensive summary of effective, patient-centered management of CAD in patients with T2DM, with emphasis on the emerging evidence. Given the increasing prevalence of T2DM and the accumulating evidence of the need to consider T2DM in treatment decisions, this knowledge will become ever more important to optimize our patients' cardiovascular outcomes.
PMID: 32279539
ISSN: 1524-4539
CID: 4560472

Diabetic Agents, From Metformin to SGLT2 Inhibitors and GLP1 Receptor Agonists: JACC Focus Seminar

Wilcox, Tanya; De Block, Christophe; Schwartzbard, Arthur Z; Newman, Jonathan D
Given the intersection between diabetes mellitus and cardiovascular disease (CVD), pharmacologic agents used to treat type 2 diabetes mellitus must show cardiovascular safety. Comorbid conditions, including heart failure and chronic kidney disease, are increasingly prevalent in patients with diabetes; therefore, they also play a large role in drug safety. Although biguanides, sulfonylurea, glitazones, and dipeptidyl peptidase 4 inhibitors have variable effects on cardiovascular events, sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists have consistently shown safety and reduction in cardiovascular events in patients with established CVD. These medications are becoming essential tools for cardioprotection for patients with diabetes and CVD. They may also have roles in primary prevention and renal protection. This paper will review the cardiovascular impact, adverse effects, and possible mechanisms of action of pharmacologic agents used to treat patients with type 2 diabetes.
PMID: 32327107
ISSN: 1558-3597
CID: 4402362

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; García-Rincón, Andrés; Starovoytov, Andrew; Łabyk, 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; Åkerblom, 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-Álvarez, 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; Ágoston, 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, Joaquín 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-Ramírez, 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; Łuczak, 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; Martínez-Ruíz, María Dolores; Canziani, Maria Eugenia; Martin, Maria Eugenia; Caetano, Maria Inês; Corral, Maria P; Pérez García, 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, Matías 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; Zdończyk, 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; García-González, Paula; Wilson, Paula; Cury Rezende, Paulo; Novis Rocha, Paulo; Canas Silva, Pedro; Farto E Abreu, Pedro; Píccaro 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, Sílvia 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-Ríos, 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

Spertus, John A; Jones, Philip G; Maron, David J; O'Brien, Sean M; Reynolds, Harmony R; Rosenberg, Yves; Stone, Gregg W; Harrell, Frank E; Boden, William E; Weintraub, William S; Baloch, Khaula; Mavromatis, Kreton; Diaz, Ariel; Gosselin, Gilbert; Newman, Jonathan D; Mavromichalis, Stavroula; Alexander, Karen P; Cohen, David J; Bangalore, Sripal; Hochman, Judith S; Mark, Daniel B; Ricci, Joseph; Tello Montoliu, A; Robero Aniorte, A I; Mulder, Abbey; Laddu, Abhay A; Goyal, Abhinav; Dubey, Abhishek; Goyal, Abhishek; Knighton, Abigail; Oomman, Abraham; Jaskowiak, Adam J; Kolodziej, Adam; Witkowski, Adam; Hameed, Adnan; Anesini, Adriana; Hussain, Afshan; Juceviciene, Agne; Urboniene, Agne; Jakal, Agnes; Szramowska, Agnieszka; Khairuddin, Ahmad; Abdel-Latif, Ahmed; Adel, Ahmed; Aljzeeri, Ahmed; Kamal, Ahmed; Talaat, Ahmed; Mann, Aimee; Contreras, Aira; Kumar, Ajit; Kumar, V K; Furukawa, Akemi; Bagai, Akshay; Smigelskaite, Akvile; Furber, Alain; Rheault, Alain; Loehr, Alaine Melanie; Rosen, Alan; 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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, Joaquín 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-Ramírez, 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; Łuczak, 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; Łoboz-Grudzień, Krystyna; Reczuch, Krzysztof W; Bury, Krzysztof; Drzymalski, Krzysztof; Kukuła, 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; Łanocha, 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; Celińska-Spodar, Małgorzta; 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; Martínez-Ruíz, María Dolores; Canales, María Fernanda; Caetano, Maria Inês; Corral, Maria P; Pérez García, 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, Matías 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; Zdończyk, 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; García-González, Paula; Rezende, Paulo Cury; Caramori, Paulo Ricardo; Kozlov, Pavel S; Canas Silva, Pedro; Melo Barros E Silva, Pedro Gabriel; Píccaro 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; Vučić, 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; 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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-Ríos, 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