Cardiovascular Surgery Discipline, Escola Paulista de Medicina and São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil.
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
Eur J Cardiothorac Surg. 2023 Nov 1;64(5). doi: 10.1093/ejcts/ezad361.
The ISCHEMIA trial is a landmark study that has been the subject of heated debate within the cardiovascular community. In this analysis of the ISCHEMIA trial, we aim to set the record straight on the benefits of coronary artery bypass grafting (CABG) and the misinterpretation of this landmark trial. We sought to clarify and reorient this misinterpretation.
We herein analyse the ISCHEMIA trial in detail and describe how its misinterpretation has led to an erroneous guideline recommendation downgrading for prognosis-altering surgical therapy in these at-risk patients.
The interim ISCHEMIA trial findings align with previous evidence where CABG reduces the long-term risks of myocardial infarction and mortality in advanced coronary artery disease. The trial outcomes of a significantly lower rate of cardiovascular mortality and a higher rate of non-cardiovascular mortality with the invasive strategy are explained according to landmark evidence.
The ISCHEMIA trial findings are aligned with previous evidence and should not be used to downgrade recommendations in recent guidelines for the indisputable benefits of CABG.
ISCHEMIA 试验是一项具有里程碑意义的研究，在心血管领域引起了激烈的争论。在这项对 ISCHEMIA 试验的分析中，我们旨在澄清和纠正对冠状动脉旁路移植术（CABG）的益处和对这一里程碑式试验的误解。我们试图澄清和重新定位这种误解。
我们在此详细分析了 ISCHEMIA 试验，并描述了其误解如何导致错误的指南建议，降低了这些高危患者预后改变的手术治疗。
中期 ISCHEMIA 试验结果与之前的证据一致，即 CABG 可降低晚期冠状动脉疾病患者心肌梗死和死亡率的长期风险。根据标志性证据，对侵入性策略的心血管死亡率显著降低和非心血管死亡率较高的试验结果进行了解释。
ISCHEMIA 试验的结果与之前的证据一致，不应用于降低最近指南中对 CABG 无可争议益处的推荐。
