January 2021 Br J Cardiol 2021;28:5–6 doi:10.5837/bjc.2021.004
Khaled Alfakih, Saad Fyyaz, Andrew Wragg
Abstract
The recently published ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial is likely to change this practice.5 The ISCHEMIA trial compared medical therapy with invasive management in patients with proven ischaemia, after excluding patients with left main stem (LMS) stenosis with CTCA, and found no difference in outcome. We suggest that the ISCHEMIA trial results are likely to shift clinical practice towards CTCA as the primary diagnostic test for new chest pain.
Current guidelines
The updated ESC guidelines1 on new stable chest pain, published in 2019, recommended investigation based o
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October 2020 Br J Cardiol 2020;27:112–4 doi:10.5837/bjc.2020.033
Telal Mudawi, Darar Al-Khdair, Muath Al-Anbaei, Asmaa Ali, Ahmed Amin, Dalia Besada, Waleed Alenezi
Abstract
The evidence
COURAGE
This study compared PCI plus optimal medical therapy with optimal medical therapy alone. There were 2,287 patients enrolled: 1,149 patients were equally randomised to receive PCI or medical therapy, testing all-cause mortality and myocardial infarction (MI) over a median of 4.6 years. The cumulative primary-event rates were not significantly different between the two groups (p=0.62). The same was the case for the composite of death, MI, and stroke (p=0.62); acute coronary syndrome (ACS) hospitalisation (p=0.56), or MI (p=0.33). The trial concluded that elective PCI confers no prognostic benefit over medical therapy alone.
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