Questionable effectiveness of stents and bypass surgery versus drug therapy in stable heart disease
Invasive procedures such as inserting stents and bypass surgery to unblock arteries in stable heart disease were significantly better than drug therapy at decreasing chest pain during exercise. However, ISCHEMIA study found no significant difference between both strategies in major heart-disease outcomes, including cardiac death, heart attacks, heart-related hospitalizations and resuscitation after cardiac arrest. Also, invasive procedures were not found beneficial in people without chest pain. The results of this study also suggest not to rush the decision of using stents and bypass surgery, as they have to be used more sparingly in patients with stable heart disease.
ISHEMIA study was presented on Saturday 23 November 2019 at the annual meeting of the American Heart Association, before its publication in a peer-reviewed journal. One of the study’s experts commented that “The ISCHEMIA trial shows that an early invasive approach does not protect patients against death or the overall chance of a heart attack, but does effectively relieve chest pain — the more chest pain a patient has, the more likely they are to benefit.” He added that ISCHEMIA study will provide doctors and patients a solid background to discuss the benefits and risks of therapeutic options. For example, an elderly person with stable heart disease who is not very active but suffers some chest pain may decide on drug therapy. A younger person whose daily activity is hindered because of more frequent chest pain could opt for an invasive procedure.