The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) published last year adds to decades of literature regarding patient selection for coronary revascularization.
1 While it is generally agreed upon that patients presenting with acute coronary syndromes should receive revascularization, the superiority of medical therapy versus revascularization in patients with stable angina remains a topic of debate. While previous retrospective literature suggested that patients with >10-12.5% ischemia on SPECT myocardial perfusion imaging who underwent revascularization had lower mortality than those who did not,
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3 the ISCHEMIA trial sought to add to the literature by prospectively assessing a patient population with a high ischemic burden. However, while this may have been the goal, it might not have been what was accomplished. …