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Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA

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Journal of Nuclear Cardiology Aims and scope

Abstract

There is a preponderance of evidence that, in the setting of an acute coronary syndrome, an invasive approach using coronary revascularization has a morbidity and mortality benefit. However, recent stable ischemic heart disease (SIHD) randomized clinical trials testing whether the addition of coronary revascularization to guideline-directed medical therapy (GDMT) reduces death or major cardiovascular events have been negative. Based on the evidence from these trials, the primary role of GDMT as a front line medical management approach has been clearly defined in the recent SIHD clinical practice guideline; the role of prompt revascularization is less precisely defined. Based on data from observational studies, it has been hypothesized that there is a level of ischemia above which a revascularization strategy might result in benefit regarding cardiovascular events. However, eligibility for recent negative trials in SIHD has mandated at most minimal standards for ischemia. An ongoing randomized trial evaluating the effectiveness of randomization of patients to coronary angiography and revascularization as compared to no coronary angiography and GDMT in patients with moderate-severe ischemia will formally test this hypothesis. The current review will highlight the available evidence including a review of the published and ongoing SIHD trials.

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Authors and Affiliations

  1. New York University School of Medicine, 530 First Avenue, SKI-9U, New York, NY, 10016, USA

    Lawrence M. Phillips MD & Harmony Reynolds MD

  2. Cleveland Clinic Foundation, Cleveland, OH, USA

    Rory Hachamovitch MD, MSc

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Daniel S. Berman MD & Sean W. Hayes MD

  4. University of Alabama – Birmingham, Birmingham, AL, USA

    Ami E. Iskandrian MD

  5. Weill Cornell Medical College, New York, NY, USA

    James K. Min MD

  6. Massachusetts General Hospital, Boston, MA, USA

    Michael H. Picard MD & Marielle Scherrer-Crosbie MD, PhD

  7. Brigham and Women’s Hospital, Boston, MA, USA

    Raymond Y. Kwong MD

  8. Montreal Heart Institute, Montreal, QC, Canada

    Matthias G. Friedrich MD & Gilbert Gosselin MD

  9. Assuta Medical Center, Tel Aviv, Israel

    Tali Sharir MD

  10. University Hospital of Ancona, Ancona, Italy

    Marco Mazzanti MD

  11. Northwick Park Hospital, London, United Kingdom

    Roxy Senior MD

  12. Ottawa Heart Institute, Ottawa, ON, Canada

    Rob Beanlands MD

  13. Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil

    Paola Smanio MD

  14. Emory University School of Medicine, Atlanta, GA, USA

    Abhi Goyal MD, MHS & Leslee J. Shaw PhD

  15. King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia

    Mouaz Al-Mallah MD

  16. New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA

    Gregg W. Stone MD

  17. Vanderbilt University, Nashville, TN, USA

    David J. Maron MD

Authors
  1. Lawrence M. Phillips MD
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  2. Rory Hachamovitch MD, MSc
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  5. James K. Min MD
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  12. Gilbert Gosselin MD
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  14. Roxy Senior MD
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  17. Abhi Goyal MD, MHS
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  18. Mouaz Al-Mallah MD
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  19. Harmony Reynolds MD
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  21. David J. Maron MD
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  22. Leslee J. Shaw PhD
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Corresponding author

Correspondence to Lawrence M. Phillips MD.

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Phillips, L.M., Hachamovitch, R., Berman, D.S. et al. Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA. J. Nucl. Cardiol. 20, 969–975 (2013). https://doi.org/10.1007/s12350-013-9773-4

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  • DOI: https://doi.org/10.1007/s12350-013-9773-4

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