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Medical Therapy With Versus Without Revascularization in Stable Patients With Moderate and Severe Ischemia: The Case for Community Equipoise.

Abstract：

:All patients with stable ischemic heart disease (SIHD) should be managed with guideline-directed medical therapy (GDMT), which reduces progression of atherosclerosis and prevents coronary thrombosis. Revascularization is also indicated in patients with SIHD and progressive or refractory symptoms, despite medical management. Whether a strategy of routine revascularization (with percutaneous coronary intervention or coronary artery bypass graft surgery as appropriate) plus GDMT reduces rates of death or myocardial infarction, or improves quality of life compared to an initial approach of GDMT alone in patients with substantial ischemia is uncertain. Opinions run strongly on both sides, and evidence may be used to support either approach. Careful review of the data demonstrates the limitations of our current knowledge, resulting in a state of community equipoise. The ongoing ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) is being performed to determine the optimal approach to managing patients with SIHD, moderate-to-severe ischemia, and symptoms that can be controlled medically. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Stone GW,Hochman JS,Williams DO,Boden WE,Ferguson TB Jr,Harrington RA,Maron DJ

doi

10.1016/j.jacc.2015.09.056

subject

Has Abstract

pub_date

2016-01-05 00:00:00

pages

81-99

issue

1

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(15)06614-0

journal_volume

67

pub_type

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