A comparative analysis has shown that patients with stable ischemic heart disease (IHD) who undergo invasive procedures—such as coronary angiography or revascularization—early in their treatment course face the same risk of all-cause mortality as those managed exclusively through conservative (non-invasive) approaches. The study’s total cohort included more than 5,000 patients. A Bayesian analysis likewise revealed no significant difference between the treatment groups. The findings were published in The Journal of the American Medical Association.
Stable ischemic heart disease is characterized by a chronic deficiency in blood supply through the coronary arteries, leading to myocardial ischemia. During episodes of exacerbation—manifesting as angina—patients experience retrosternal pain that may radiate to the left shoulder, neck, or lower jaw; this pain typically subsides within about 15 minutes. Standard management and prevention strategies for the condition primarily involve lipid-lowering therapy and the use of antiplatelet agents.
Invasive procedures, such as coronary angiography, are frequently employed to diagnose the condition, while more severe cases may require coronary revascularization. However, with the widespread adoption of statins, numerous studies have indicated that the benefits of invasive interventions for stable IHD do not always surpass those of pharmacological treatment alone. Nevertheless, due to variations in definitions and therapeutic approaches, the available data remain fragmented. A team of researchers led by Judith Hochman at NYU Langone Medical Center analyzed long-term follow-up data from the randomized ISCHEMIA trial, which examined mortality rates associated with various interventions in patients with stable ischemic heart disease (IHD). In the invasive intervention group, patients also received medical therapy. The final study cohort consisted of 5,179 participants. The mean age at the start of the study was 64 years; 23 percent of the participants were women, and 42 percent had diabetes mellitus. The median duration of follow-up was nine years.
Cumulative all-cause mortality over 11 years did not differ between the group that underwent invasive procedures and the group that received conservative (medical) management. According to a Bayesian analysis, the posterior probability that invasive interventions would improve survival by more than one percentage point was low—18 percent. Over the 11-year period, cardiovascular mortality was 15.8 percent in the invasive intervention group, compared to 17.1 percent in the medical therapy group; the hazard ratio for non-cardiovascular mortality was 1.18.
Judith Hochman et al. / The Journal of the American Medical Association, 2026
The researchers conclude that routine invasive interventions for stable IHD do not significantly affect mortality compared to a conservative management strategy. They also suggest that these findings will enable patients to make more informed decisions regarding their IHD treatment.
In some cases, the heart can suffer even when blood flow through the coronary vessels remains normal. For instance, we reported on a case of stress cardiomyopathy in an elderly woman that was triggered by an exceptionally intense feeling of happiness at her daughter’s wedding.
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