Podcast 564:  Cardiac Ischemia Management Update

<p><strong>Contributor: Nick Tsipis, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Recent randomized controlled trial compared early intervention (PCI/CABG) to medical management for those diagnosed with moderate to severe cardiac ischemia on stress testing</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Primary outcome was</span> <span style= "font-weight: 400;">a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Secondary outcome was death from cardiovascular causes or myocardial infarction.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">The study reported that patients who had more aggressive invasive procedures early on in treatment had a 2% increase in poor outcomes in the immediate period after intervention (6 months) but long term had a 2% decrease in poor outcomes.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Overall the mortality was essentially identical between the two groups</span></li> </ul> <p><strong>References</strong></p> <p><a href= "https://www.ncbi.nlm.nih.gov/pubmed/32227755"><strong>1)</strong></a> <span style="font-weight: 400;">Maron, D.J.,</span> <em><span style="font-weight: 400;">et al</span></em><span style= "font-weight: 400;">. Initial Invasive or Conservative Strategy for Stable Coronary Disease.</span> <a href= "https://www.ncbi.nlm.nih.gov/pubmed/32227755"><span style= "font-weight: 400;">N Engl J Med.</span></a> <span style= "font-weight: 400;">2020 Apr 9;382(15):1395-1407. doi: 10.1056/NEJMoa1915922. Epub 2020 Mar 30.</span></p>