- For stable coronary artery disease (CAD) in advanced kidney disease, initial surgical vs conservative management does not differ for mortality or nonfatal myocardial infarction (MI) risk.
- Stroke incidence was higher with an initial invasive approach.
- Results are from the ISCHEMIA-CKD trial.
Why this matters
- A trial from the early 1990s found a benefit of revascularization in this patient population, but much has changed in the ensuing decades, say these authors.
- Estimated 3-year event rates for the primary composite outcome of death/nonfatal MI:
- 36.4% invasive vs 36.7% conservative.
- Difference, −0.4% (95% CI, −8.5 to 7.8).
- Adjusted HR: 1.01 (95% CI, 0.79-1.29).
- Estimated 3-year event rates for the secondary composite outcome (death/nonfatal MI or hospitalization for unstable angina, heart failure, resuscitated cardiac arrest):
- 38.5% invasive vs 39.7% conservative.
- HR, 1.01 (95% CI, 0.79-1.29).
- Stroke incidence was higher with invasive strategy: HR, 3.76 (95% CI, 1.52-9.32).
- Most strokes were nonprocedural.
- Multinational (30 countries, 118 sites) study of 777 patients with advanced kidney disease who were randomly allocated to initial invasive or conservative management strategy for moderate-severe ischemia.
- Funding: US National Heart, Lung, and Blood Institute.
- Highly selected participant population, so generalization not clear.