1. Myocardial Infarction in the ISCHEMIA Trial
- Author
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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, and Group, On behalf of the ISCHEMIA Research
- Subjects
Clinical Trials and Supportive Activities ,Clinical Research ,Cost Effectiveness Research ,Heart Disease ,Cardiovascular ,Heart Disease - Coronary Heart Disease ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Coronary Artery Bypass ,Creatine Kinase ,MB Form ,Female ,Follow-Up Studies ,Humans ,Incidence ,Male ,Middle Aged ,Myocardial Infarction ,Myocardial Ischemia ,Percutaneous Coronary Intervention ,Prognosis ,Proportional Hazards Models ,Risk Factors ,Severity of Illness Index ,Survival Analysis ,catheterization ,drug therapy ,myocardial infarction ,myocardial ischemia ,myocardial revascularization ,ISCHEMIA Research Group ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology - Abstract
BackgroundIn the ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), an initial invasive strategy did not significantly reduce rates of cardiovascular events or all-cause mortality in comparison with a conservative strategy in patients with stable ischemic heart disease and moderate/severe myocardial ischemia. The most frequent component of composite cardiovascular end points was myocardial infarction (MI).MethodsISCHEMIA prespecified that the primary and major secondary composite end points of the trial be analyzed using 2 MI definitions. For procedural MI, the primary MI definition used creatine kinase-MB as the preferred biomarker, whereas the secondary definition used cardiac troponin. Procedural thresholds were >5 times the upper reference level for percutaneous coronary intervention and >10 times for coronary artery bypass grafting. Procedural MI definitions included (1) a category of elevated biomarker only events with much higher biomarker thresholds, (2) new ST-segment depression of ≥1 mm for the primary and ≥0.5 mm for the secondary definition, and (3) new coronary dissections >National Heart, Lung, and Blood Institute grade 3. We compared MI type, frequency, and prognosis by treatment assignment using both MI definitions.ResultsProcedural MIs 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 versus conservative strategy using the primary (2.7% versus 1.1%; adjusted hazard ratio [HR], 2.98 [95% CI, 1.87-4.73]) and secondary (8.2% versus 2.0%; adjusted HR, 5.04 [95% CI, 3.64-6.97]) MI definitions. Type 1 MIs were less frequent with the invasive versus conservative strategy using the primary (3.40% versus 6.89%; adjusted HR, 0.53 [95% CI, 0.41-0.69]; P
- Published
- 2021