Stable Coronary Artery Disease: Who Finally Benefits from Coronary Revascularization in the Modern Era? The ISCHEMIA and Interim ISCHEMIA-EXTEND Analysis

Leonid Bershtein; Alexey Sumin; Elizaveta Zbyshevskaya; Victoria Gumerova; Darejan Tsurtsumia; Igor Kochanov; Alina Andreeva; Vartan Piltakian; Sergey Sayganov

doi:10.3390/life13071497

Stable Coronary Artery Disease: Who Finally Benefits from Coronary Revascularization in the Modern Era? The ISCHEMIA and Interim ISCHEMIA-EXTEND Analysis

Life (Basel). 2023 Jul 1;13(7):1497. doi: 10.3390/life13071497.

Authors

Leonid Bershtein¹, Alexey Sumin², Elizaveta Zbyshevskaya¹, Victoria Gumerova¹, Darejan Tsurtsumia³, Igor Kochanov⁴, Alina Andreeva⁵, Vartan Piltakian⁶, Sergey Sayganov⁷

Affiliations

¹ Department of Internal Medicine & Cardiology, North-Western State Medical University named after II Mechnikov, 191015 St. Petersburg, Russia.
² Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Disease", Sosnovy Blvd. 6, 650002 Kemerovo, Russia.
³ Department of Internal Medicine #1, North-Western State Medical University named after II Mechnikov, 191015 St. Petersburg, Russia.
⁴ Department of Interventional Cardiology, North-Western State Medical University named after II Mechnikov, 191015 St. Petersburg, Russia.
⁵ Department of Functional Diagnostics, North-Western State Medical University named after II Mechnikov, 191015 St. Petersburg, Russia.
⁶ St. Petersburg State Budgetary Healthcare Institution 'Pokrovskaya City Hospital', 199034 St. Petersburg, Russia.
⁷ North-Western State Medical University named after II Mechnikov, 191015 St. Petersburg, Russia.

Abstract

Coronary revascularization is one of the most studied treatment modalities in cardiology; however, there is no consensus among experts about its indications in patients with stable coronary artery disease (SCAD). Contemporary data regarding the role of revascularization in SCAD are in clear conflict with the current European guidelines. This article discusses the main statements of the most significant American and European Guidelines on myocardial revascularization of the last decade and also analyzes the appropriateness of revascularization to improve the prognosis and symptoms in SCAD in the light of new research data, primarily the ISCHEMIA study (NCT01471522) and the ACC/AHA 2021 Revascularization Guidelines based on them. Data on the revascularization in SCAD obtained after the completion of ISCHEMIA (including the interim analysis of ISCHEMIA-EXTEND) and their potential significance are discussed. The results of ISCHEMIA sub-analyses in the most important "controversial" subgroups (3-vessel disease, proximal left anterior descending artery disease, strongly positive stress test, etc.) are reviewed, as are the results of the ISCHEMIA-CKD substudy in patients with severe chronic kidney disease (CKD).

Keywords: ISCHEMIA; ISCHEMIA-EXTEND; chronic coronary syndromes; prognosis; revascularization.

Publication types

Review

Grants and funding

Sub-grant: grant U01HL105907 from the US Department of Health Human Services, the Public Health Service, the National Institutes of Health (NIH), and the National Heart, Lung, and Blood Institute (NHLBI) dated 22 July 2011, to conduct a multi-site, multi-national clinical investigation entitled “International Study of Comparative Health Effectiveness with Medical and Invasive Approaches”.