Mayo Clinic cardiologist Raymond J. Gibbons, M.D., discusses the success and cautionary indicators of the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial. Baseline characteristics and risk profiles of participants in the ISCHEMIA randomized clinical trial was published in February 2019 in JAMA Cardiology. 

In the past, patients with an abnormal stress test would be referred to the Mayo Clinic Cardiac Catheterization Laboratory for early coronary angiography. However, after participating in two large randomized trials — the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial and Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial — Mayo Clinic found that patients who received optimal medical therapy did just as well as patients who underwent stenting or bypass surgery.

The ISCHEMIA trial, funded by the National Institutes of Health, was the largest randomized trial ever performed in patients with chronic coronary artery disease. Results of the trial, whose estimated completion date is December 2019, will set a new standard in the treatment of chronic coronary artery disease.