# Invasief versus conservatief bij stabiel coronairlijden met HF of lage EF: ISCHEMIA substudie

*geplaatst 2020-11-03 · Hartfalen · Circulation · doi 10.1161/CIRCULATIONAHA.120.050304 · https://hartvaat.nl/2020/11/03/invasief-versus-conservatief-bij-stabiel-coronairlijden-met-hf-of-lage-ef-ischem/*

ISCHEMIA substudie bij patiënten met een voorgeschiedenis van hartfalen of verminderde LV-functie.

## English: Initial Invasive Versus Conservative Management of Stable Ischemic Heart Disease in Patients With a History of Heart Failure or Left Ventricular Dysfunction: Insights From the ISCHEMIA Trial.

This ISCHEMIA substudy in patients with a history of heart failure or reduced LV function found no significant interaction between heart failure status and the benefit of initial invasive versus conservative management of stable ischemic heart disease.

## Abstract (original, from the publication)

BACKGROUND: Whether an initial invasive strategy in patients with stable ischemic heart disease and at least moderate ischemia improves outcomes in the setting of a history of heart failure (HF) or left ventricular dysfunction (LVD) when ejection fraction is ≥35% but <45% is unknown. METHODS: Among 5179 participants randomized into ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), all of whom had left ventricular ejection fraction (LVEF) ≥35%, we compared cardiovascular outcomes by treatment strategy in participants with a history of HF/LVD at baseline versus those without HF/LVD. Median follow-up was 3.2 years. RESULTS: There were 398 (7.7%) participants with HF/LVD at baseline, of whom 177 had HF/LVEF >45%, 28 HF/LVEF 35% to 45%, and 193 LVEF 35% to 45% but no history of HF. HF/LVD was associated with more comorbidities at baseline, particularly previous myocardial infarction, stroke, and hypertension. Compared with patients without HF/LVD, participants with HF/LVD were more likely to experience a primary outcome composite of cardiovascular death, nonfatal myocardial infarction, or hospitalization for unstable angina, HF, or resuscitated cardiac arrest (4-year cumulative incidence rate, 22.7% versus 13.8%; cardiovascular death or myocardial infarction, 19.7% versus 12.3%; and all-cause death or HF, 15.0% versus 6.9%). Participants with HF/LVD randomized to the invasive versus conservative strategy had a lower rate of the primary outcome (17.2% versus 29.3%; difference in 4-year event rate, -12.1% [95% CI, -22.6 to -1.6%]), whereas those without HF/LVD did not (13.0% versus 14.6%; difference in 4-year event rate, -1.6% [95% CI, -3.8% to 0.7%]; P interaction = 0.055). A similar differential effect was seen for the primary outcome, all-cause mortality, and cardiovascular mortality when invasive versus conservative strategy-associated outcomes were analyzed with LVEF as a continuous variable for patients with and without previous HF. CONCLUSIONS: ISCHEMIA participants with stable ischemic heart disease and at least moderate ischemia with a history of HF or LVD were at increased risk for the primary outcome. In the small, high-risk subgroup with HF and LVEF 35% to 45%, an initial invasive approach was associated with better event-free survival. This result should be considered hypothesis-generating. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.

Auteurs: Renato D Lopes, Karen P Alexander, Susanna R Stevens, Harmony R Reynolds, Gregg W Stone, Ileana L Piña, Frank W Rockhold, Ahmed Elghamaz, Jose Luis Lopez-Sendon, Pedro S Farsky, Alexander M Chernyavskiy, Ariel Diaz, Denis Phaneuf, Mark A De Belder, Yi-Tong Ma, Luis A Guzman, Michel Khouri, Alessandro Sionis, Derek J Hausenloy, Rolf Doerr, Joseph B Selvanayagam, Aldo Pietro Maggioni, Judith S Hochman, David J Maron

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.120.050304. Bijgewerkt 2026-07-03T13:28:01Z. 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.