Thread:

Great pre-game analysis of ISCHEMIA here. Bear in mind also that important info about the trial population has been published: https://jamanetwork.com/journals/jamacardiology/article-abstract/2725865

What are some key takeaways? https://twitter.com/rwyeh/status/1194638074765967362

2/ For background, patients with positive stress tests got referred for enrollment. The stress tests had to be judged to have moderate or large ischemia.

Some key exclusions included:
1) small ischemia
2) severe baseline symptoms
3) LMCA dz

3/ About 8500 patients were referred for randomization. But about 5200 got randomized. What happened to the rest?

They either had small ischemia, or left main disease, or no epicardial CAD dz > 50% on a CTA (false + stress or microvascular dz)

4/ When reviewed by Core lab, 85% of randomized patients had confirmed moderate or large ischemia.

45% had 3VD and 47% had prox LAD dz based on CTA thresholds of 50% or greater stenosis

5/ While 80% of patients had angina within the prior month, this was NOT a highly symptomatic population.

Only ~ 25% of patients had angina at least weekly.

Grand majority of patients had angina monthly or less.

this is not surprising since significant sx ecluded upfront.

6/ I anticipate that the trial will overall be negative for death/MI.

If true, given the above, this will tell us that it is generally safe to conservatively manage mildly symptomatic folks with positive stress tests as an initial strategy.

7/ As Bobby implied in excellent thread above, this would largely be a confirmation of existing evidence.

Given size and importance of this trial, this confirmation will be important for our conversations with patients.