Long-Term Survival After Initial Invasive or Conservative Management of Stable Coronary Disease in Patients With Advanced Chronic Kidney Disease: ISCHEMIA-CKD EXTEND.

In ISCHEMIA-CKD patients with at least moderate myocardial ischemia and advanced chronic kidney disease, 8-year all-cause mortality was similar with initial invasive versus conservative management (57.4% vs 56.8%).

• Why it matters: The trial showed comparable short-term death or nonfatal myocardial infarction, but whether initial invasive care improves long-term survival in advanced chronic kidney disease was unknown.
• What they did: Participants were randomized to an initial invasive strategy (coronary angiography with revascularization when feasible) plus guideline-directed medical therapy or to guideline-directed medical therapy alone with invasive procedures reserved for failure; long-term vital status was tracked for a median of 8 years.
• The result: All-cause mortality (adjusted hazard ratio 1.05, 95% CI 0.87–1.28) and cardiovascular mortality (adjusted hazard ratio 1.06, 95% CI 0.84–1.34) did not differ, implying no significant long-term survival benefit of initial invasive care.

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