Causes of Cardiovascular and Non-Cardiovascular Death in the ISCHEMIA Trial

Autor: Sidhu MS, Alexander KP, Huang Z, O'Brien SM, Chaitman BR, Stone GW, Newman JD, Boden WE, Maggioni AP, Steg PG, Ferguson TB, Demkow M, Peteiro J, Wander GS, Phaneuf DC, De Belder MA, Doerr R, Alexanderson-Rosas E, Polanczyk CA, Henriksen PA, Conway DSG, Miro V, Sharir T, Lopes RD, Min JK, Berman DS, Rockhold FW, Balter S, Borrego D, Rosenberg YD, Bangalore S, Reynolds HR, Hochman JS, Maron DJ, ISCHEMIA Research Group
Rok vydání: 2022
Předmět:
Zdroj: AMERICAN HEART JOURNAL
r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
instname
ISSN: 0002-8703
Popis: BACKGROUND: The ISCHEMIA trial demonstrated no overall difference in the composite primary endpoint and the secondary endpoints of cardiovascular (CV) death/myocardial infarction or all-cause mortality between an initial invasive or conservative strategy among participants with chronic coronary disease and moderate or severe myocardial ischemia. Detailed cause-specific death analyses have not been reported. METHODS: We compared overall and cause-specific death rates by treatment group using Cox models with adjustment for pre-specified baseline covariates. Cause of death was adjudicated by an independent Clinical Events Committee as cardiovascular (CV), non-CV, and undetermined. We evaluated the association of risk factors and treatment strategy with cause of death. RESULTS: Four-year cumulative incidence rates for CV death were similar between invasive and conservative strategies [2.6% vs. 3.0%; hazard ratio (HR) 0.98; 95% CI (0.70 - 1.38)], but non-CV death rates were higher in the invasive strategy [3.3% vs. 2.1%; HR 1.45 (1.00 - 2.09)]. Overall, 13% of deaths were attributed to undetermined causes (38/289). Fewer undetermined deaths [0.6% vs. 1.3%; HR 0.48 (0.24 - 0.95)] and more malignancy deaths [2.0% vs. 0.8%; HR 2.11 (1.23 - 3.60)] occurred in the invasive strategy than in the conservative strategy. CONCLUSIONS: In ISCHEMIA, all-cause and CV death rates were similar between treatment strategies. The observation of fewer undetermined deaths and more malignancy deaths in the invasive strategy remains unexplained. These findings should be interpreted with caution in the context of prior studies and the overall trial results.
Databáze: OpenAIRE
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