Trial reportJournal of the American College of Cardiology2025
Guideline-Directed Medical Therapy and Outcomes in the ISCHEMIA Trial.
Trial report in Journal of the American College of Cardiology, 2025. 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 6 papers.
What it found
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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
6 citing papers in PubMed.
- Sex differences in coronary disease health Status outcomes: the ISCHEMIA trial.European heart journal. Quality of care & clinical outcomes · 2026Trial
- Incremental Impact of Standard Modifiable Cardiovascular Risk Factors on Long-Term Outcomes After Acute Myocardial Infarction.JACC. Asia · 2026Article
- Whole blood epigenomic and transcriptomic characterization identifies vulnerable molecular subtypes of chronic coronary disease.Nature communications · 2026Article
- Tracing the evolution of cardiology: Pioneering discoveries and paradigm shifts in cardiovascular care.American heart journal plus : cardiology research and practice · 2026Review
- Article
- Prognostic implication of time in target range of systolic blood pressure in patients with hypertension after coronary artery bypass grafting.Frontiers in cardiovascular medicine · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
28 authors.
Funding
Abstract
backgroundGuideline-directed medical therapy (GDMT) with multiple risk factor goals is recommended for patients with chronic coronary disease (CCD), yet achieving all GDMT goals is uncommon. The relative importance of these goals and timing of their attainment on cardiovascular events is uncertain.
objectivesThis study aims to describe the relationship between achieving specific GDMT goals, when they are achieved, and clinical outcomes.
methodsThis was an observational study of participants with CCD in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial. The primary outcome was cardiovascular (CV) death or myocardial infarction (MI). GDMT goals were systolic blood pressure (SBP) <130 mm Hg, low-density lipoprotein cholesterol <70 mg/dL, not smoking, and antiplatelet therapy. Frequency of GDMT goals met at baseline and during follow-up is described. Bayesian joint modeling for longitudinal goal status and time-to-event analyses characterized the relative importance of specific GDMT goal attainment and timing with CV death/MI.
resultsAll 5,179 ISCHEMIA participants were included. Among 4,914 participants with complete data on all 4 GDMT goals at baseline, 386 (9%), 2,073 (42%), 1,843 (38%), and 612 (12%) met 0-1, 2, 3, and 4 GDMT goals, respectively. The 4-year cumulative event rate for CV death/MI was highest for participants who attained no GDMT goals (24.5%; 95% credible interval [CrI]: 13.5%-42.2%) and lowest for those who attained all goals at baseline and remained at goal during follow-up (8.7%; 95% CrI: 6.7%-10.9%). SBP goal attainment was associated with a significant absolute event reduction in CV death/MI (-5.1%; 95% CrI: -11.3% to -1.0%), followed by antiplatelet therapy (-11.2%; 95% CrI: -29.1% to 0.8%), achieving low-density lipoprotein cholesterol <70 mg/dL (-2.0%; 95% CrI: -6.0% to 2.4%), and not smoking (-1.7%; 95% CrI: -9.3% to 4.2%). Ten millimeters of mercury lower SBP during follow-up was associated with 10% relative risk reduction of CV death/MI (RR [relative risk] = 0.90; 95% CrI: 0.82-0.98), after adjusting for other GDMT goals and baseline characteristics.
conclusionsAmong participants with CCD, early attainment and maintenance of GDMT goals, especially SBP, were associated with fewer cardiovascular events. Compared with no GDMT goals at target, having all 4 GDMT goals at target at baseline was associated with an absolute 16% fewer CV deaths and MIs. (ISCHEMIA [International Study of Comparative Health Effectiveness With Medical and Invasive Approaches]; NCT01471522).
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