By: JBizNews Desk 🌎
Patients with stable coronary artery disease can start with medicines and lifestyle changes, reserving stents or bypass surgery for when that treatment fails, without giving up a long-term survival benefit from having routine procedures early. A new international follow-up study found similar death rates for the two treatment strategies after nearly a decade, giving patients and doctors more evidence for choosing when an invasive procedure is worth its risks and expense.
The findings come from ISCHEMIA-EXTEND, a follow-up to a trial of more than 5,000 people with stable coronary disease and abnormal stress tests. NYU Langone Health announced the results Saturday in its study release.
The early invasive strategy was associated with a 26% chance of death, compared with 27% for the medicines-first strategy. Researchers recorded 1,071 deaths up to 13 years after patients entered the study and established whether 96% of participants were alive or had died.
Different starting points, similar survival
Patients were enrolled at 320 hospitals in 37 countries. Everyone received medicines to manage cholesterol and blood pressure, along with diet and exercise counseling.
One group also underwent heart procedures early after an abnormal stress test. The other started with medical treatment, with procedures reserved for worsening symptoms, a heart attack or failure of medical therapy.
The follow-up compared long-term survival between those strategies. Researchers used direct contact with patients and national health records to track outcomes.
Chest-pain relief remains an important benefit
Earlier results from the trial found that an initial invasive strategy relieved chest pain and improved quality of life for patients with chest pain. The new survival findings help separate that symptom benefit from the question of whether having procedures early extends life.
That distinction gives patients a clearer basis for discussing treatment goals with their doctors: relief from symptoms, better daily function, the risks of a procedure and the timing of treatment.
The findings concern stable disease, not heart attacks
Stable coronary disease involves narrowed arteries that restrict blood flow without the sudden complete blockage seen in a heart attack. The researchers said procedures that open or bypass blocked arteries remain lifesaving for patients having heart attacks or threatened heart attacks.
NYU Langone said the results are being presented November 7 at the American Heart Association’s Scientific Sessions and published online in the Journal of the American Medical Association. The National Institutes of Health funded ISCHEMIA-EXTEND.
JBizNews Desk | New York
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