Evidence mapPaperPMID 39432255Full record

Trial reportEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2024

Outcomes with revascularisation versus conservative management of participants with 3-vessel coronary artery disease in the ISCHEMIA trial.

Sripal Bangalore, Grace Rhodes, David J Maron, Rebecca Anthopolos, Sean M O'Brien, Philip G Jones, Daniel B Mark, Harmony R Reynolds, John A Spertus, Gregg W Stone and 5 more

Registry-linked trialAbstract readComparative StudyRandomized Controlled Trial
In one paragraph

Trial report in EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01471522 (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01471522 nacompletednot on this map

International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA)

TypeinterventionalSponsorNYU Langone HealthRan2012 to 2023Enrolled5,179ConditionsCardiovascular Diseases, Coronary Disease, Coronary Artery Disease, Heart DiseasesArmscardiac catheterization, coronary artery bypass graft surgery, percutaneous coronary intervention, Lifestyle, Medication
3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Sripal BangaloreDepartment of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Grace RhodesDuke Clinical Research Institute, Durham, NC, USA.
David J MaronDepartment of Medicine, Stanford University, Stanford, CA, USA.
Rebecca AnthopolosDepartment of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Sean M O'BrienDuke Clinical Research Institute, Durham, NC, USA.
Philip G JonesSaint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
Daniel B MarkDuke Clinical Research Institute, Durham, NC, USA.
Harmony R ReynoldsDepartment of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
John A SpertusSaint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
Gregg W StoneThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Harvey D WhiteTe Whatu Ora Health New Zealand, Te Toka Tumai, Green Lane Cardiovascular Services and University of Auckland, Auckland, New Zealand.
Yifan XuDepartment of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Stephen E FremesUniversity of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Judith S HochmanDepartment of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
On Behalf Of The Ischemia Research Group

Funding

Clinical and Translational Science AwardUL1TR001445 · NCATS · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2022 to 2025
$25.0M
Vanderbilt Institute for Clinical and Translational Research (VICTR)UL1TR002243 · VANDERBILT UNIVERSITY MEDICAL CENTER · 2025 to 2025
$10.7M
Integrated Biostatistical Training for CVD ResearchT32HL079896 · NORTH CAROLINA STATE UNIVERSITY RALEIGH · 2025 to 2025
$327k
NCATS NIH HHS UL1 TR001445NCATS NIH HHS UL1 TR002243NHLBI NIH HHS T32 HL079896NHLBI NIH HHS U01 HL105462NHLBI NIH HHS U01 HL105561NHLBI NIH HHS U01 HL105565NHLBI NIH HHS U01 HL105907
6 · The paper itself

Abstract

backgroundWhether revascularisation (REV) improves outcomes in patients with three-vessel coronary artery disease (3V-CAD) is uncertain.

aimsOur objective was to evaluate outcomes with REV (percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]) versus medical therapy in patients with 3V-CAD.

methodsISCHEMIA participants with 3V-CAD on coronary computed tomography angiography without prior CABG were included. Outcomes following initial invasive management (INV) with REV (PCI or CABG) versus initial conservative management (CON) with medical therapy alone were evaluated. Regression modelling was used to estimate the outcomes if all participants were to undergo prompt REV versus those assigned to CON. Outcomes were cardiovascular (CV) death/myocardial infarction (MI), death, CV death, and quality of life. Bayesian posterior probability for benefit (Pr [benefit]) for 1 percentage point lower 4-year rates with REV versus CON were evaluated.

resultsAmong 1,236 participants with 3V-CAD (612 INV/624 CON), REV was associated with lower 4-year CV death/MI (adjusted 4-year difference: -4.4, 95% credible interval [CrI] -8.7 to -0.3 percentage points, Pr [benefit]=94.8%) when compared with CON, with similar results for PCI versus CON (-5.8, 95% CrI: -10.8 to -0.5 percentage points, Pr [benefit]=96.4%) and CABG versus CON (-3.7, 95% CrI: -8.8 to 1.5 percentage points, Pr [benefit]=84.7%). Adjusted 4-year REV versus CON differences were as follows: death -1.2 (95% CrI: -4.7 to 2.2) percentage points, CV death -2.3 (95% CrI: -5.5 to 0.8) percentage points, with similar results for PCI and for CABG. The Pr (benefit) for death with REV (PCI or CABG) versus CON was 49-63%. The adjusted 12-month Seattle Angina Questionnaire-7 summary score differences favoured REV: REV versus CON 4.6 (95% CrI: 2.7-6.4) percentage points; PCI versus CON 3.6 (95% CrI: 1.2-5.8) percentage points and CABG versus CON 4.3 (95% CrI: 1.5-6.9) percentage points with high Pr (benefit).

conclusionsIn participants with 3V-CAD, REV (either PCI or CABG) was associated with a lower 4-year CV death/MI rate and improved quality of life, with similar results for PCI versus CON and CABG versus CON. The differences in all-cause mortality between REV and CON were small with wide confidence intervals. (ClinicalTrials.gov: NCT01471522).

Indexed as

Conservative TreatmentCoronary Artery BypassCoronary Artery DiseasePercutaneous Coronary InterventionAgedCoronary AngiographyFemaleHumansMaleMiddle AgedMyocardial InfarctionQuality of LifeTreatment Outcome

Identifiers

PMID39432255
PMCPMC11472139

What Socratic holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.