ISCHEMIA trial results may increase coronary CTA use
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Results from the ISCHEMIA trial may lead to increased use of coronary CT angiography to determine risk for events, according to a presentation at Society of Cardiovascular Computed Tomography Annual Scientific Meeting.
David J. Maron, MD, clinical professor of medicine and director of preventive cardiology and of Stanford Prevention Research Center at Stanford University School of Medicine and co-chair of the ISCHEMIA trial, said use of coronary CTA may be important in patients with stable ischemic heart disease going forward because the findings showed that anatomy, not ischemia, predicted events in that population. As Healio previously reported, an invasive strategy of revascularization plus optimal medical therapy and a conservative strategy of optimal medical therapy alone yielded similar long-term CV outcomes in stable patients with moderate or severe ischemia.
Before patients were asked to participate in the ISCHEMIA trial, researchers performed non-imaging exercise treadmill testing, exercise echocardiography, cardiac MRI or single- photon emission CT to determine ischemia status. If the patient was included in the trial, they then underwent a blinded coronary CTA.
“The reason we blinded the test, meaning that the patient [and] the referring physician didn’t know the results ... was because we didn’t want patients that had very severe stenoses to be excluded from the trial,” Maron said during the presentation. “The reason we did CCTA was for patients’ safety so we could exclude left main disease where there is consensus that those patients should be treated with revascularization. We did not do CCTA on patients that had a [glomerular filtration rate] less than 60 [mL/min/1.73 m2] or if their coronary anatomy was already known from a previous cath.”
Prespecified subgroup analyses in this trial determined that the risk for an event did not increase as the severity of ischemia increased. In addition, the risk for an event increased as anatomy worsened.
“Anatomy predicted events, although with the anatomic severity increasing the risk, the invasive strategy did not reduce that risk,” he said.
Maron mentioned that more analyses will be performed from the ISCHEMIA trial. He said, “We do plan on analyzing plaque morphology, and I’m confident that we’re going to learn more about predicting risk from that analysis.”
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Maron DJ. Cardiovascular CT in 2020: Current Developments, Guidelines and Trials. Presented at: Society of Cardiovascular Computed Tomography Annual Scientific Meeting; July 17-18, 2020 (virtual).
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