Long-Term Survival After Initial Invasive or Conservative Management of Stable Coronary Disease in ISCHEMIA-EXTEND.

In ISCHEMIA-EXTEND, routine initial invasive management of stable chronic coronary disease did not significantly change 11-year all-cause mortality versus conservative care (25.8% vs 26.9%).

• Why it matters: It addresses whether adding an invasive strategy to guideline-directed medical therapy improves long-term survival in high-risk chronic coronary disease, where benefit is uncertain.
• What they did: In a long-term follow-up of 5179 randomized patients across 37 countries, investigators compared invasive care plus angiography/revascularization versus medical therapy alone, analyzing mortality through Cox/Fine-Gray and Bayesian methods.
• The result: At 11 years, cardiovascular mortality was 15.8% vs 17.1% and noncardiovascular mortality 9.1% vs 8.1%, with no significant differences in all-cause mortality (AHR 0.97) and low Bayesian probability of >1% benefit (18%).

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