Sökning: onr:"swepub:oai:DiVA.org:uu-457629" > Outcomes in the ISC...
Fältnamn | Indikatorer | Metadata |
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000 | 06145naa a2200601 4500 | |
001 | oai:DiVA.org:uu-457629 | |
003 | SwePub | |
008 | 211101s2021 | |||||||||||000 ||eng| | |
024 | 7 | a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4576292 URI |
024 | 7 | a https://doi.org/10.1161/CIRCULATIONAHA.120.0497552 DOI |
040 | a (SwePub)uu | |
041 | a engb eng | |
042 | 9 SwePub | |
072 | 7 | a ref2 swepub-contenttype |
072 | 7 | a art2 swepub-publicationtype |
100 | 1 | a Reynolds, Harmony R.u NYU, Grossman Sch Med, New York, NY USA.4 aut |
245 | 1 0 | a Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity |
264 | 1 | b Lippincott Williams & Wilkins,c 2021 |
338 | a print2 rdacarrier | |
520 | a BACKGROUND: The ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) postulated that patients with stable coronary artery disease (CAD) and moderate or severe ischemia would benefit from revascularization. We investigated the relationship between severity of CAD and ischemia and trial outcomes, overall and by management strategy.METHODS: In total, 5179 patients with moderate or severe ischemia were randomized to an initial invasive or conservative management strategy. Blinded, core laboratory-interpreted coronary computed tomographic angiography was used to assess anatomic eligibility for randomization. Extent and severity of CAD were classified with the modified Duke Prognostic Index (n=2475, 48%). Ischemia severity was interpreted by independent core laboratories (nuclear, echocardiography, magnetic resonance imaging, exercise tolerance testing, n=5105, 99%). We compared 4-year event rates across subgroups defined by severity of ischemia and CAD. The primary end point for this analysis was all-cause mortality. Secondary end points were myocardial infarction (MI), cardiovascular death or MI, and the trial primary end point (cardiovascular death, MI, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest).RESULTS: Relative to mild/no ischemia, neither moderate ischemia nor severe ischemia was associated with increased mortality (moderate ischemia hazard ratio [HR], 0.89 [95% CI, 0.61-1.30]; severe ischemia HR, 0.83 [95% CI, 0.57-1.21]; P=0.33). Nonfatal MI rates increased with worsening ischemia severity (HR for moderate ischemia, 1.20 [95% CI, 0.86-1.69] versus mild/no ischemia; HR for severe ischemia, 1.37 [95% CI, 0.98-1.91]; P=0.04 for trend, P=NS after adjustment for CAD). Increasing CAD severity was associated with death (HR, 2.72 [95% CI, 1.06-6.98]) and MI (HR, 3.78 [95% CI, 1.63-8.78]) for the most versus least severe CAD subgroup. Ischemia severity did not identify a subgroup with treatment benefit on mortality, MI, the trial primary end point, or cardiovascular death or MI. In the most severe CAD subgroup (n=659), the 4-year rate of cardiovascular death or MI was lower in the invasive strategy group (difference, 6.3% [95% CI, 0.2%-12.4%]), but 4-year all-cause mortality was similar.CONCLUSIONS: Ischemia severity was not associated with increased risk after adjustment for CAD severity. More severe CAD was associated with increased risk. Invasive management did not lower all-cause mortality at 4 years in any ischemia or CAD subgroup. | |
650 | 7 | a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kardiologi0 (SwePub)302062 hsv//swe |
650 | 7 | a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Cardiac and Cardiovascular Systems0 (SwePub)302062 hsv//eng |
653 | a coronary artery bypass | |
653 | a coronary artery disease | |
653 | a ischemia | |
653 | a myocardial revascularization | |
653 | a percutaneous coronary intervention | |
700 | 1 | a Shaw, Leslee J.u New York Presbyterian Hosp, Weill Cornell Med, New York, NY USA.4 aut |
700 | 1 | a Min, James K.u Cleerly Inc, New York, NY USA.4 aut |
700 | 1 | a Page, Courtney B.u Duke Clin Res Inst, Durham, NC USA.4 aut |
700 | 1 | a Berman, Daniel S.u Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA.4 aut |
700 | 1 | a Chaitman, Bernard R.u St Louis Univ, Sch Med, Ctr Comprehens Cardiovasc Care, St Louis, MO USA.4 aut |
700 | 1 | a Picard, Michael H.u Massachusetts Gen Hosp, Boston, MA 02114 USA.;Harvard Med Sch, Boston, MA 02115 USA.4 aut |
700 | 1 | a Kwong, Raymond Y.u Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA.4 aut |
700 | 1 | a O'Brien, Sean M.u Duke Clin Res Inst, Durham, NC USA.4 aut |
700 | 1 | a Huang, Zhenu Duke Clin Res Inst, Durham, NC USA.4 aut |
700 | 1 | a Mark, Daniel B.u Duke Clin Res Inst, Durham, NC USA.4 aut |
700 | 1 | a Nath, Ranjit K.u Dr Ram Manohar Lohia Hosp, New Delhi, India.4 aut |
700 | 1 | a Dwivedi, Sudhanshu K.u King Georges Med Univ, Lucknow, Uttar Pradesh, India.4 aut |
700 | 1 | a Smanio, Paola E. P.u Inst Dante Pazzanese Cardiol Fleury Med, Sao Paulo, Brazil.4 aut |
700 | 1 | a Stone, Peter H.u Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA.4 aut |
700 | 1 | a Held, Claes,d 1956-u Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi4 aut0 (Swepub:uu)clahe947 |
700 | 1 | a Keltai, Matyasu Semmelweis Univ, Budapest, Hungary.4 aut |
700 | 1 | a Bangalore, Sripalu NYU, Grossman Sch Med, New York, NY USA.4 aut |
700 | 1 | a Newman, Jonathan D.u NYU, Grossman Sch Med, New York, NY USA.4 aut |
700 | 1 | a Spertus, John A.u Univ Missouri, St Lukes Midamer Heart Inst, Kansas City, KS USA.4 aut |
700 | 1 | a Stone, Gregg W.u Icahn Sch Med Mt Sinai, Cardiovasc Res Fdn, New York, NY 10029 USA.4 aut |
700 | 1 | a Maron, David J.u Stanford Univ, Dept Med, Stanford, CA 94305 USA.4 aut |
700 | 1 | a Hochman, Judith S.u NYU, Grossman Sch Med, New York, NY USA.4 aut |
710 | 2 | a NYU, Grossman Sch Med, New York, NY USA.b New York Presbyterian Hosp, Weill Cornell Med, New York, NY USA.4 org |
773 | 0 | t Circulationd : Lippincott Williams & Wilkinsg 144:13, s. 1024-1038q 144:13<1024-1038x 0009-7322x 1524-4539 |
856 | 4 8 | u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-457629 |
856 | 4 8 | u https://doi.org/10.1161/CIRCULATIONAHA.120.049755 |
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