Impact of the ISCHEMIA randomized clinical trial on the management of patients with chronic coronary syndrome

Abstract Background In the ISCHEMIA trial, patients with chronic coronary syndromes (CCS) and moderate or severe ischemia had no significant difference in combined ischemic events an initial invasive compared a conservative strategy [1]. Coronary computed tomography angiography (CCTA) was part of pre-randomization workup is gaining popularity over testing (ICA) as diagnostic for CCS [2]. Purpose To analyse whether results trial sizeable impact on algorithm by analysing trends referral to ICA and/or revascularization. Methods ICAs performed between November 2019 February 2022 at high-volume centre were analysed. Two groups defined based procedure date: i) pre-ISCHEMIA, including before March 2020 (date publication); ii) post-ISCHEMIA, ≥3 months (i.e., blanking period) after publication. The primary outcome incidence CCTA. Secondary objectives included revascularization testing, CCTA, CCTA that did not require further intervention. Results A total 2,365 qualified analysis, which 487 (20.6%) 1878 (79.4%) pre-ISCHEMIA post-ISCHEMIA groups, respectively. There notable differences baseline characteristics groups. occurred more frequently group (73.5% vs 32.5%, p<0.01). Referral lower (31.6%, 52.5% p<0.01), while frequent (8.3% 12.0% (3.4% 3.0%, p=0.73) intervention (60.3% 60.8%, p=0.90). Conclusions At two years from publication, seems have impacted significantly decision-making CCS. frequency considerably increased, paralleled decreased testing. Funding Acknowledgement Type funding sources: None.