Pharmaceuticals and lifestyle change can be as effective as stents or cardiac surgery in tackling stable coronary artery disease, a landmark study has found.
Importantly, it also found there is no need to rush patients with stable heart disease, and moderate-to-severe myocardial ischemia, into invasive procedures like these.
Conducted over more than three years in 37 countries, the ISCHEMIA clinical trials analysed comparisons of 5179 cardiac patients.
It found conservative early treatment of stable coronary disease is as effective as early angiography or revascularisation for patients with and without advanced coronary disease.
(An angiogram is an X-ray of the arteries in the heart; a stent may be inserted as part of the procedure. Revascularisation is restoration of blood flow to the heart, usually via bypass surgery.)
"We did not find evidence that the initial invasive strategy reduced the risk of ischaemic cardiovascular events such as heart attacks or strokes, or death from any cause," said lead Australian researcher Joseph Selvanayagam.
"This trial's results show there is no need to rush patients with stable coronary disease, and moderate-to-severe myocardial ischemia, to invasive coronary angiography," he said..
"It is perfectly safe to treat these patients with cholesterol-lowering drugs, anti-platelet drugs and antianginal drugs, and then monitor their progress."
The mean age of participants was in the trial was 64, with 77% of them male. All had stable coronary disease and moderate-to-severe ischaemia.
Professor Selvanayagam, from Flinders University, said the study had a "very important message for the number one health condition in Australia".
"In most cases, patients in the medical therapy arm did perfectly fine and did not need to have invasive angiography and stenting/bypass," he said.
The findings of the ISCHEMIA trials underscore the benefits of modern pharmacotherapy for stable coronary disease, according to the final report.
"Provided there is strict adherence to guideline-based medical therapy, patients with ischaemic heart disease who fit the profile of those in ISCHEMIA and do not have unacceptable levels of angina can be treated with an initial conservative strategy,"
The results of the trials were first reported at the American Heart Association meeting last November and have now been published in the New England Journal of Medicine.
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