(HealthDay News) — For patients with stable coronary disease and moderate-to-severe ischemia, an initial invasive strategy does not improve outcomes, but it may improve angina-related health status, according to two studies published online in the New England Journal of Medicine.

David J. Maron, MD, from the Stanford University School of Medicine in California, and colleagues randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy and medical therapy or an initial conservative strategy of medical therapy alone. The researchers identified 318 and 352 primary outcome events (composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) in the invasive- and conservative-strategy groups, respectively, during a median of 3.2 years. There were 145 and 144 deaths, respectively (hazard ratio, 1.05; 95% confidence interval, 0.83 to 1.32).

John A. Spertus, MD, MPH, from Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and colleagues assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) among participants with stable ischemic heart disease and moderate or severe ischemia randomly assigned to an invasive treatment strategy (2,295 participants) or a conservative strategy (2322 participants). The researchers found that in both treatment groups, there were increases in SAQ summary scores, with 4.1-, 4.2-, and 2.9-point greater increases with the invasive versus the conservative strategy at three, 12, and 36 months, respectively.

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“These findings should be applied in the context of careful attention to lifestyle behaviors and guideline-based adherence to medical therapy, and will likely change clinical guidelines and influence clinical practice,” a coauthor of both studies said in a statement.

Both studies were partially funded by Arbor Pharmaceuticals and AstraZeneca; devices or medications were provided by pharmaceutical and biomedical companies.


Maron DJ, Hochman JS, Reynolds HR, et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease. N Engl J Med. 382:1395-1407
doi: 10.1056/NEJMoa1915922

Spertus JA, Jones PG, Maron DJ, et al. Health-Status Outcomes with Invasive or Conservative Care in Coronary Disease. N Eng J Med. 

Antman EM and Braunwald E. Managing Stable Ischemic Heart Disease. N Engl J Med.