@article{5b9ab60a57284d26beeaeec80d93c9c9,
title = "Evaluating the Appropriate Use Criteria for Coronary Revascularization in Stable Ischemic Heart Disease Using Randomized Data From the ISCHEMIA Trial",
abstract = "BACKGROUND: The appropriate use criteria for revascularization of stable ischemic heart disease have not been evaluated using randomized data. Using data from the randomized ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches; July 2012 to January 2018, 37 countries), the health status benefits of an invasive strategy over a conservative one were examined within appropriate use criteria scenarios. METHODS: Among 1833 participants mapped to 36 appropriate use criteria scenarios, symptom status was assessed using the Seattle Angina Questionnaire-7 at 1 year for each scenario and for each of the 6 patient characteristics used to define the scenarios. Coronary anatomy and SYNTAX(Synergy between percutaneous coronary intervention with Taxus and cardiac surgery) scores were measured using coronary computed tomography angiography. Treatment effects are expressed as an odds ratio for a better health status outcome with an invasive versus conservative treatment strategy using Bayesian hierarchical proportional odds models. Differences in the primary clinical outcome were similarly examined. RESULTS: The mean age was 63 years, 81% were male, and 71% were White. Diabetes was present in 28% and multivessel disease in 51%. Most clinical scenarios favored invasive for better 1-year health status. The benefit of an invasive strategy on Seattle Angina Questionnaire angina frequency scores was reduced for asymptomatic patients (odds ratio [95% credible interval], 1.16 [0.66-1.71] versus 2.26 [1.75-2.80]), as well as for those on no antianginal medications. Diabetes, number of diseased vessels, proximal left anterior descending coronary artery location, and SYNTAX score did not effectively identify patients with better health status after invasive treatment, and minimal differences in clinical events were observed. CONCLUSIONS: Applying the randomization scheme from the ISCHEMIA trial to appropriate clinical scenarios revealed baseline symptoms and antianginal therapy to be the primary drivers of health status benefits from invasive management. Consideration should be given to reducing the patient characteristics collected to generate appropriateness ratings to improve the feasibility of future data collection.",
keywords = "Bayes theorem, computed tomography angiography, conservative treatment, coronary vessels, myocardial ischemia, questionnaires, random allocation",
author = "James Slater and Maron, {David J.} and Jones, {Philip G.} and Sripal Bangalore and Reynolds, {Harmony R.} and Zhuxuan Fu and Stone, {Gregg W.} and Ruth Kirby and Hochman, {Judith S.} and Spertus, {John A.} and {ISCHEMIA Research Group} and Kreton Mavromatis and Jason Linefsky and Todd Miller and Subhash Banerjee and Newman, {Jonathan D.} and Donnino, {Robert M.} and Muhamed Saric and Khaled Abdul-Nour and Stone, {Peter H.} and Jang, {James J.} and Gennie Yee and Steven Weitz and Suzanne Arnold and O'keefe, {James Henry} and Shapiro, {Michael D.} and Fein, {Steven A.} and Torosoff, {Mikhail T.} and Radmila Lyubarova and Sulagna Mookherjee and Krzysztof Drzymalski and Mcfalls, {Edward O.} and Garcia, {Santiago A.} and Bertog, {Stefan C.} and Siddiqui, {Rizwan A.} and Areef Ishani and Hansen, {Ronnell A.} and Khouri, {Michel Georges} and Goldberg, {Jonathan L.} and Richard Goldweit and Cohen, {Ronny A.} and Brooks Mirrer and Victor Navarro and Winchester, {David E.} and Marvin Kronenberg and Christopher Mcfarren and Heitner, {John F.} and Dauber, {Ira M.} and Charles Cannan and Sriram Sudarshan and Mehta, {Puja K.} and Michael Mcdaniel and Stamatios Lerakis and Arshed Quyyumi and Wenger, {Nanette K.} and Hedgepeth, {Chester M.} and Heather Hurlburt and Alan Rosen and Zakir Sahul and Steve Leung and Hassan Reda and Khaled Ziada and Sampoornima Setty and Barua, {Rajat S.} and Fadi Hage and Davies, {James E.} and Massoud Leesar and Jaekyeong Heo and Amy Iskandrian and {Al Solaiman}, Firas and Satinder Singh and Khaled Dajani and Mohammad El-Hajjar and {Der Mesropian}, Paul and Joseph Sacco and Brian Mccandless and Marisa Orgera and Sidhu, {Mandeep S.} and Imran Arif and Hanan Kerr and Trejo, {Jorge F.} and Gerald Fletcher and Lane, {Gary E.} and Neeson, {Lynn M.} and Parikh, {Pragnesh P.} and Pollak, {Peter M.} and Shapiro, {Brian P.} and Kevin Landolfo and Anthony Gemignani and Daniel O'rourke and Meadows, {Judith L.} and Call, {Jason T.} and Joseph Hannan and Robert Bojar and Deepti Kumar and John Mukai and Martin, {Edward T.} and Gabriel Vorobiof and Alec Moorman and Scott Kinlay and Hamburger, {Robert J.} and Rocco, {Thomas P.} and Bhatt, {Deepak L.} and Kevin Croce and Quin, {Jacquelyn A.} and Jati Anumpa and Marco Zenati and Faxon, {David P.} and Glenn Rayos and Ashraf Seedhom and Lance Sullenberger and Gregory Kumkumian and Sedlis, {Steven P.} and Jeffrey Lorin and Tamis-Holland, {Jacqueline E.} and Robert Kornberg and Robert Leber and Souheil Saba and Lee, {Michael W.} and Small, {Delano R.} and Wassim Nona and Alexander, {Patrick B.} and Iram Rehman and Umesh Badami and Kevin Marzo and Robbins, {Inga H.} and Levite, {Howard A.} and Sanjay Shetty and Mayuri Patel and Hamroff, {Glenn S.} and Little, {Raymond W.} and Zimbelman, {Brandi D.} and Lui, {Charles Y.} and Smith, {Brigham R.} and Vezina, {Daniel P.} and Khor, {Lillian L.} and Abraham, {Josephine D.} and Bull, {David A.} and Mckellar, {Stephen H.} and David Booth and John Kotter and Ahmed Abdel-Latif and Bob Hu and Labovitz, {Arthur J.} and Michael Berlowitz and Philip Rogal and Fadi Matar and Christiano Caldeira and Fatima Rodriguez and Ingela Schnittger and Fearon, {William F.} and Prakash Deedwania and Kiran Reddy and Joseph Sweeny and Christopher Spizzieri and Hochberg, {Claudia P.} and Salerno, {William D.} and Ray Wyman and Amer Zarka and Shah, {Anil V.} and Thomas Haldis and Kohn, {Jeffrey A.} and Saket Girotra and Omar Almousalli and Krishnam, {Mayil S.} and Milliken, {Jeffrey C.} and Patel, {Pranav M.} and Seto, {Arnold H.} and Harley, {Kevin T.} and Gibson, {Michael A.} and Allen, {Byron J.} and Rita Coram and Sabu Thomas and Schwartz, {Ronald G.} and Wei Chen and {El Shahawy}, Mahfouz and James Stafford and Abernethy, {William B.} and Andrew Zurick and Meyer, {Thomas M.} and Morford, {Ronald G.} and Bruce Rutkin and Sabahat Bokhari and Sokol, {Seth I.} and Jay Meisner and Ihab Hamzeh and Arunima Misra and Matthew Wall and {De Rosen}, {Veronica Lenges} and Mahboob Alam and Turner, {Michael C.} and Mulhearn, {Thomas J.} and Good, {Arnold P.} and Shammas, {Nicolas W.} and Robert Chilton and Nguyen, {Patricia K.} and Matthew Jezior and Gordon, {Paul C.} and Thomas Crain and Robert Stenberg and Pedalino, {Ronald P.} and Joseph Wiesel and Juang, {George J.} and Mohammed Al-Amoodi and David Wohns and Lader, {Ellis W.} and Michael Mumma and Lekshmi Dharmarajan and Mcgarvey, {Joseph F.X.} and Downes, {Thomas R.} and Luckasen, {Gary J.} and Benjamin Cheong and Srinivasa Potluri and Mastouri, {Ronald A.} and Breall, {Jeffery A.} and Revtyak, {George E.} and Bazeley, {Jonathan W.} and Dayuan Li and Kenneth Giedd and Wayne Old and Francis Burt and Kozhaya Sokhon and Deepika Gopal and Valeti, {Uma S.} and Jon Kobashigawa and Govindan, {Sajeev Chakanalil} and Nair, {Rajesh Gopalan} and Manjunath, {Cholenahally Nanjappa} and Nagaraja Moorthy and Manjunath, {Satvic Cholenahally} and Suryaprakash Narayanappa and Neeraj Pandit and Nath, {Ranjit Kumar} and Dwivedi, {S. K.} and Narain, {V. S.} and Sharad Chandra and Wander, {Gurpreet S.} and Rohit Tandon and Sarju Ralhan and Naved Aslam and Abhishek Goyal and G. Karthikeyan and S. Ramakrishnan and Sandeep Seth and Rakesh Yadav and Sandeep Singh and Ambuj Roy and Neeraj Parakh and Verma, {Sunil Kumar} and Selvanayagam, {Joseph B.} and Joseph, {Majo X.}",
year = "2025",
month = mar,
doi = "10.1161/CIRCOUTCOMES.124.010849",
language = "English",
volume = "18",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "American Heart Association",
number = "3",
}
