{"id":"ca983c5d179d","type":"article","url":"https://hartvaat.nl/2025/04/01/ischemia-invasief-versus-conservatief-bij-chronische-totale-occlusie/","title":"ISCHEMIA: invasief versus conservatief bij chronische totale occlusie","title_en":"Invasive vs Conservative Management of Patients With Chronic Total Occlusion: Results From the ISCHEMIA Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.01.029","source_url":"https://doi.org/10.1016/j.jacc.2025.01.029","authors":["Sripal Bangalore","G B John Mancini","Jonathan Leipsic","Mathew J Budoff","Yifan Xu","Rebecca Anthopolos","Emmanouil S Brilakis","Aeshita Dwivedi","John A Spertus","Phil G Jones","Yoon Joo Cho","Daniel B Mark","Cameron J Hague","James K Min","Harmony R Reynolds","Ahmed Elghamaz","Rajesh Goplan Nair","Kreton Mavromatis","Gilbert Gosselin","Subhash Banerjee","Hristo Pejkov","Steven Lindsay","J Aaron Grantham","David O Williams","Gregg W Stone","Sean M O'Brien","Judith S Hochman","David J Maron"],"significance":7,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/kleplijden/aortaregurgitatie/"],"congress":"","summary_en":"This ISCHEMIA subanalysis in patients with chronic total occlusions showed no benefit of invasive management over conservative treatment, consistent with the overall trial findings and dedicated CTO trials.","created":"2026-07-03T10:31:34Z","updated":"2026-07-03T13:30:35Z","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":"ISCHEMIA-subanalyse bij chronische totale occlusie (CTO) toonde dat invasief management geen voordeel biedt boven conservatief beleid bij CTO in de setting van stabiel coronairlijden.","abstract_original":"BACKGROUND: Randomized trials of chronic total occlusion (CTO) revascularization vs medical therapy have yielded inconsistent results. OBJECTIVES: The aim of this study was to evaluate outcomes with an initial invasive strategy (INV) vs an initial conservative strategy (CON) in patients with coronary computed tomographic angiography (CCTA)-determined CTO in the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial. METHODS: Participants in ISCHEMIA who underwent CCTA evaluated for CTO by the core laboratory (3,113 of 5,179 randomized patients [60%]) were categorized into subgroups with (100% stenosis) and without (<100% stenosis) CTO. Primary analysis compared outcomes in those randomized to INV vs CON using an intention-to-treat approach. Secondary analyses compared outcomes using inverse probability weighting to model successful CTO revascularization (REV) in all INV participants vs CON participants. RESULTS: Of the 3,113 CCTA-evaluable participants, 1,470 had at least 1 CTO (752 INV and 718 CON). INV did not reduce cardiovascular (CV) death or myocardial infarction (MI) (5-year difference -3.5%; 95% CI: -7.8% to 0.8%) and resulted in more procedural MIs (2.5%; 95% CI: 1.0%-4.0%) but fewer spontaneous MIs (-6.3%; 95% CI: -9.7% to -3.2%) than CON. CTO REV modeled across INV had a high probability (>90%) of any lower CV death or MI, MI, spontaneous MI, unstable angina, and heart failure counterbalanced by a higher rate of procedural MI. CTO REV significantly improved angina-related quality of life (mean difference 4.6 points), Rose Dyspnea Scale score (rescaled) (mean difference 5.3 points), and EQ-5D visual analog scale score (4.6 points). CONCLUSIONS: In the ISCHEMIA trial, the risks and benefits of INV compared with CON were similar among patients with and without CCTA-determined CTO (more frequent procedural MI, less frequent spontaneous MI, and significantly improved angina and dyspnea-related quality of life). In an observational comparison, successful CTO REV was associated with a high probability of lower CV death or MI (driven by lower MI) compared with CON. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522)."}