Understanding the ISCHEMIA Trial Findings
Background
The ISCHEMIA Trial explored how stress-induced ischemia relates to coronary artery disease (CAD) severity. Factors influencing this relationship include:
- Intensity of stress during testing
- Type of stress test used
- History of heart attacks
- Blood flow from collateral vessels
- Characteristics of plaque
- Microvascular health
- Coronary blood vessel tone
- Genetic factors
We focused on patients with moderate to severe ischemia to see how stress test results correlated with CAD severity as seen on coronary computed tomography angiography (CTA).
Methods
Participants underwent various stress tests, including:
- Nuclear imaging
- Echocardiography
- Cardiac magnetic resonance imaging
- Non-imaging exercise tests
We analyzed the relationship between ischemia and CAD using data from these tests, categorizing ischemia as severe, moderate, mild, or none, and assessing CAD severity with the modified Duke prognostic index.
Results
Among 3,601 participants, we found:
- A weak association between ischemia severity and CAD extent/severity (r=0.27).
- Variability based on stress test modality:
- Nuclear imaging: r=0.40
- Echocardiography: r=0.15
- Cardiac MRI: r=0.31
- Exercise test: r=0.18
- Extent of infarction showed weak associations with CAD severity.
Conclusions
In this study, ischemia severity had weak to moderate correlations with CAD extent among patients with moderate or severe ischemia. This suggests that while there is some relationship, it is not strong.
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