{"id":"e39faf3c16df","type":"article","url":"https://hartvaat.nl/2020/04/23/gezondheidsstatus-na-invasieve-of-conservatieve-zorg-bij-coronairlijden-met-gevo/","title":"Gezondheidsstatus na invasieve of conservatieve zorg bij coronairlijden met gevorderde CKD: NEJM ISCHEMIA-CKD QoL","title_en":"Health Status after Invasive or Conservative Care in Coronary and Advanced Kidney Disease.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","hartkatheterisatie","perifeer-vaatlijden","stabiel-coronairlijden"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1916374","source_url":"https://doi.org/10.1056/NEJMoa1916374","authors":["John A Spertus","Philip G Jones","David J Maron","Daniel B Mark","Sean M O'Brien","Jerome L Fleg","Harmony R Reynolds","Gregg W Stone","Mandeep S Sidhu","Bernard R Chaitman","Glenn M Chertow","Judith S Hochman","Sripal Bangalore"],"significance":7,"published":"2020-04-23","source_date":"2020-04-23","image":"","kennis":[],"congress":"","summary_en":"The ISCHEMIA-CKD quality-of-life analysis showed that an initial invasive strategy did not significantly improve health status compared with conservative management in patients with stable coronary disease and advanced kidney disease.","created":"2026-07-03T10:28:31Z","updated":"2026-07-03T13:27:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM ISCHEMIA-CKD kwaliteit-van-levenanalyse bij coronairlijden met gevorderde nierziekte.","abstract_original":"BACKGROUND: In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS: We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS: Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, -0.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, -2.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, -1.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, -2.2 to 3.4). CONCLUSIONS: Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy. (Funded by the National Heart, Lung, and Blood Institute; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.)."}