Published: Tue, November 19, 2019
Health Care | By Cedric Leonard

ISCHEMIA study goes to the heart of medicine vs medical intervention question

ISCHEMIA study goes to the heart of medicine vs medical intervention question

On Saturday, the researchers presented their findings at the American Heart Association's scientific meeting.

"For patients with stable ischemic heart disease, but with mild symptoms of angina (chest pain) that doesn't hamper their routine functions, the best way to treat is targeted medical therapy".

The study, called Ischemia, examined the use of traditional preventive measures in patients with heart disease who are at serious risk of heart attack.

The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (Ischemia), funded by the United States government and led by researchers from the New York University Grossman School of Medicine and Stanford University, had tracked 5,179 patients in 37 countries.

It must be noted that stents and bypass surgeries are still necessary and potentially life-saving for those who have suffered from a heart attack and that this study concerns only those who have stable angina (chest pain) issues. "Patients without angina will not see an improvement, but those with angina of any severity will tend to have a greater, lasting improvement in quality of life if they have an invasive heart procedure". This can ultimately lead to heart attack.

The 7-year, 5,179-patient ISCHEMIA study did not show a significant benefit from that course of action.

"I would hope this would change practice", said Dr. William Boden of the VA New England Healthcare System, another study author. There were 145 deaths in the group that was randomized to receive stents or bypass in addition to medical therapy, compared with 144 among those who received medication alone.

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Dr Aashish Contractor, Director (Rehabilitation and Sports Medicine), Sir HN Reliance Foundation Hospital, says, "The study reinforces the understanding that for stable heart disease, medical management and lifestyle changes are the mainstay therapy".

The trial, sponsored by the National Heart, Lung and Blood Institute, involved patients with moderate to severe but stable ischemia - a condition in which clogged arteries are not able to supply the heart with enough oxygen-rich blood.

The results suggest that these patients could have been treated through optimal medical therapy - a combination of medicines such as aspirin, anti-lipid statins and anti-blood-pressure drugs - to achieve the same level of protection available from invasive procedures.

Experts said the study was well done, and its findings will be hard to ignore.

The study results did not apply to patients with current/ recent, acute coronary syndrome, highly symptomatic patients or those with blocks in the left main coronary artery, the study said.

One doctor said there is another benefit in taking heart medications instead of surgery.

Roy added: "In emergency situations, including unstable angina or a heart attack, catherisation and coronary stent implantation is a life-saving procedure".

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