Relationship Between Severity of Ischemia and Coronary Artery Disease for Different Stress Test Modalities in the ISCHEMIA Trial

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.

Clinical Implications

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