Trial reportCirculation2021
Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity.
Trial report in Circulation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. 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 126 papers, 2 of them syntheses that pooled 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.
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.
International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA)
Who cites it
126 citing papers in PubMed, 2 syntheses or guidelines pooled it, 256 citations in OpenAlex.
- Coronary CT angiography alone versus with CT perfusion: a systematic review and meta-analysis assessing approaches for chest pain.European radiology · 2025Pooled it
- Assessment of Coronary Microvascular Dysfunction by Angiography-Based Index of Microcirculatory Resistance: An Indirect Meta-Analysis.Cardiology · 2025Pooled it
- Additive prognostic value of functional performance to coronary artery anatomy: the ISCHEMIA trial.European heart journal. Cardiovascular Imaging · 2026Trial
- Stress Cardiac Magnetic Resonance Ischemia Burden and Cardiovascular Events: Post-Hoc Analysis From the ISCHEMIA Trial.JACC. Cardiovascular imaging · 2026Trial
- Comparative Prognosis by Stress ECG and Stress Imaging: Results From the ISCHEMIA Trial.JACC. Cardiovascular imaging · 2025Trial
- Extent of coronary artery disease and clinical outcomes with ticagrelor monotherapy versus aspirin after coronary artery bypass grafting: insights from the TiCAB trial.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025Trial
- Stress Echocardiography in Patients With Moderate or Severe Myocardial Ischemia: Insights From the ISCHEMIA Trial.Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography · 2025Trial
- Evaluating the Appropriate Use Criteria for Coronary Revascularization in Stable Ischemic Heart Disease Using Randomized Data From the ISCHEMIA Trial.Circulation. Cardiovascular quality and outcomes · 2025Trial
- Sex Differences in Computed Tomography Coronary Stenosis Severity Versus Flow Impairment and Impact on Revascularization, Clinical Events and Health Care Costs: A FORECAST Substudy.Journal of the American Heart Association · 2025Trial
- Relationship Between Severity of Ischemia and Coronary Artery Disease for Different Stress Test Modalities in the ISCHEMIA Trial.Circulation. Cardiovascular interventions · 2024Trial
- Outcomes with revascularisation versus conservative management of participants with 3-vessel coronary artery disease in the ISCHEMIA trial.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2024Trial
- Atherosclerosis quantification and cardiovascular risk: the ISCHEMIA trial.European heart journal · 2024Trial
- Variation in Health Status With Invasive vs Conservative Management of Chronic Coronary Disease.Journal of the American College of Cardiology · 2024Trial
- Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial.Journal of the American Heart Association · 2024Trial
- Impact of Complete Revascularization in the ISCHEMIA Trial.Journal of the American College of Cardiology · 2023Trial
- The Effects of Cardiac Rehabilitation including Nordic Walking in Patients with Chronic Coronary Syndromes after Percutaneous Coronary Interventions in Elective Mode.Medicina (Kaunas, Lithuania) · 2023Trial
- Trial
- Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: a substudy of the ORBITA trial.European heart journal · 2022Trial
- Comparison of risk profiles of participants in the Women's IschemiA TRial to Reduce events In non-ObstRuctive CAD (WARRIOR) trial, using Coronary Computed Tomography Angiography vs Invasive Coronary Angiography.Progress in cardiovascular diseasesTrial
- Invasive and medical management approaches to non-acute myocardial ischaemic syndromes.Nature reviews. Cardiology · 2026Review
66 more citing papers are in PubMed but not listed here.
Corrections and comments
- Erratum issued
- Erratum issued
Authors and funding
23 authors at 18 institutions in 7 countries.
Funding
Abstract
backgroundThe ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) postulated that patients with stable coronary artery disease (CAD) and moderate or severe ischemia would benefit from revascularization. We investigated the relationship between severity of CAD and ischemia and trial outcomes, overall and by management strategy.
methodsIn total, 5179 patients with moderate or severe ischemia were randomized to an initial invasive or conservative management strategy. Blinded, core laboratory-interpreted coronary computed tomographic angiography was used to assess anatomic eligibility for randomization. Extent and severity of CAD were classified with the modified Duke Prognostic Index (n=2475, 48%). Ischemia severity was interpreted by independent core laboratories (nuclear, echocardiography, magnetic resonance imaging, exercise tolerance testing, n=5105, 99%). We compared 4-year event rates across subgroups defined by severity of ischemia and CAD. The primary end point for this analysis was all-cause mortality. Secondary end points were myocardial infarction (MI), cardiovascular death or MI, and the trial primary end point (cardiovascular death, MI, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest).
resultsRelative to mild/no ischemia, neither moderate ischemia nor severe ischemia was associated with increased mortality (moderate ischemia hazard ratio [HR], 0.89 [95% CI, 0.61-1.30]; severe ischemia HR, 0.83 [95% CI, 0.57-1.21];
conclusionsIschemia severity was not associated with increased risk after adjustment for CAD severity. More severe CAD was associated with increased risk. Invasive management did not lower all-cause mortality at 4 years in any ischemia or CAD subgroup. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01471522.
Indexed as
Identifiers
What OpenQuestion holds
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 OpenQuestion graph.