News | SCAI | May 17, 2020

ISCHEMIA Trial: Patients With Intermediate Left Main Coronary Disease Have Worse Cardiovascular Events

ISCHEMIA Trial: Patients With Intermediate Left Main Coronary Disease Have Worse Cardiovascular Events. #SCAI2020

May 17, 2020 – A new study shows that when compared with patients without intermediate left main coronary artery disease, those with intermediate left main disease have greater risk of cardiovascular events. The findings of the ISCHEMIA trial sub study were presented during the Society for Cardiovascular Angiography and Interventions (SCAI) 2020 Virtual Conference  as featured clinical research.

“Our study showed that when compared with patients without intermediate left main disease, those with intermediate left main disease had worse outcomes,” said Sripal Bangalore, M.D., FSCAI, director of the cardiac catheterization laboratory at Bellevue Hospital and lead author of the study. “However, there was no treatment interaction such that the outcomes with invasive vs. conservative were similar whether or not the patient had intermediate left main disease on CCTA.”

The presence of left main disease (LMD) typically provokes both emotional and evidence-based concerns that apart from trials done in the 1980s, patients with left main disease have been excluded from trials of revascularization vs. medical therapy. ISCHEMIA also excluded patients with left main disease, although patients with intermediate left main disease (25-49%) were allowed. The outcomes of these patients and the effect of invasive vs. conservative strategy has not been explored before.

In the study, randomized ISCHEMIA trial participants who underwent coronary computed tomography angiography (CCTA) at baseline were categorized into those with (25-49%) and without (<25%) intermediate LMD as determined by a core lab. Patients with LMD ≥50%, those with prior coronary artery bypass graft surgery (CABG), and those with non-evaluable or missing data on LM stenosis were excluded. Both clinical and quality of life (QoL) outcomes in those with and without intermediate LMD were compared, as well as outcomes of participants randomized to an initial invasive versus conservative strategy.

ISCHEMIA randomized 5,179 participants to an initial invasive or conservative strategy; those who underwent coronary CCTA comprise the LMD sub study cohort. Among the 3,913 participants who underwent CCTA, 3,699 satisfied the inclusion criteria. Of these participants, 962 (26%) had intermediate LMD and 2,737 (74%) did not. Among invasive strategy participants with intermediate LMD, 7.0% had significant LM stenosis on invasive angiography. The primary outcome event rate was significantly higher in those with intermediate LMD as compared to those without intermediate LMD (adjusted HR=1.31; 95% CI 1.06 to 1.61; P=0.0123).

Find links to the rest of the SCAI late-breaking trials and other SCAI news
 

Related ISCHEMIA Trial Content:

ISCHEMIA Sub-study Shows Chest Pain, Stress Tests Warrant Attention Even If Arteries Are Clear

Sex Differences in Stress Test and CCTA Findings and Symptoms in the Ischemia Trial

ISCHEMIA Trial Results Find Interventions for Stable Heart Disease No better Than Drug Therapy

VIDEO: The Impact of the ISCHEMIA Trial on Cardiac Imaging
 

Related Content

With the advent and optimization of nuclear scintigraphy protocols using bone-avid radiotracers, cardiac amyloidosis caused by transthyretin protein (ATTR) can now be diagnosed noninvasively without a costly tissue biopsy. The radiotracer 99mTc-pyrophosphate (99mTc-PYP) binds to deposited ATTR amyloid fibrils in the myocardium and can be visualized using planar and SPECT imaging. Amyloidosis Patient Registry  #Amyloidosis

With the advent and optimization of nuclear scintigraphy protocols using bone-avid radiotracers, cardiac amyloidosis caused by transthyretin protein (ATTR) can now be diagnosed noninvasively without a tissue biopsy. The radiotracer 99mTc-pyrophosphate (99mTc-PYP) binds to deposited ATTR amyloid fibrils in the myocardium and can be visualized using planar and SPECT imaging. This is Figure 2, showing how SPECT imaging allows the reader to distinguish between blood pool activity (ventricular cavity, etc) and myocardial activity and identify regional myocardial differences in radiotracer uptake.

News | Cardiac Diagnostics | March 05, 2020
March 5, 2020 — More than 300 patients have joined the Amyloidosis Patient Registry and it is now available to the en
heart disease image
News | Cardiac Diagnostics | December 18, 2019
December 18, 2019 — In their latest report, “...
FDA Warns Troponin Tests Impacted by Biotin Dietary Supplement
Feature | Cardiac Diagnostics | November 05, 2019 | Dave Fornell, Editor
November 5, 2019 — The U.S.
Videos | Cardiac Diagnostics | October 29, 2019
Doctor Clyde Yancy was a keynote speaker and said doctors need to check their assumptions about patients at the door...
79-year-old Tony Marovic had a right carotid endarterectomy shortly after discovering a 95 percent blockage of his carotid artery at a health and wellness screening event

79-year-old Tony Marovic had a right carotid endarterectomy shortly after discovering a 95 percent blockage of his carotid artery at a health and wellness screening event. Image courtesy of University Hospitals.

News | Cardiac Diagnostics | October 16, 2019
Health and wellness screenings are more than just nice events for the community – they can save lives. A Mentor, Ohio,...
Pesticide Exposure May Increase Heart Disease and Stroke Risk

Image courtesy of zefe wu from Pixabay

News | Cardiac Diagnostics | October 15, 2019
On-the-job exposure to high levels of pesticides raised the risk of heart disease and stroke in a generally healthy...
World Heart Federation Launches Global Roadmap on Cardiovascular Disease Prevention Among Diabetics
News | Cardiac Diagnostics | September 04, 2019
At the European Society of Cardiology (ESC) Congress 2019 together with the World Congress of Cardiology, the World...
Insomnia Tied to Higher Risk of Heart Disease and Stroke

Image courtesy of the American Heart Association

News | Cardiac Diagnostics | August 19, 2019
People suffering from insomnia may have an increased risk of coronary artery disease, heart failure and stroke,...