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Research Letter
Less Is More
September 21, 2020

Potential Association of the ISCHEMIA Trial With the Appropriate Use Criteria Ratings for Percutaneous Coronary Intervention in Stable Ischemic Heart Disease

Author Affiliations
  • 1St Luke’s Mid America Heart Institute, Kansas City, Missouri
  • 2Duke University, School of Medicine, Durham, North Carolina
  • 3Virginia Tech Carilion School of Medicine, Roanoke, Virginia
JAMA Intern Med. Published online September 21, 2020. doi:10.1001/jamainternmed.2020.3181

Decreasing the risk for major adverse cardiovascular events (eg, myocardial infarction and death) and alleviating symptoms are primary therapeutic goals of percutaneous coronary intervention (PCI) in patients with stable ischemic heart disease (SIHD). Current appropriate use criteria (AUC) developed by national cardiovascular societies classify PCIs as appropriate, maybe appropriate, or rarely appropriate.1 Recently, the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial reported that coronary revascularization did not lower cardiovascular event rates among patients with SIHD2 but did improve the disease-specific health status of patients if they had angina.3 We sought to understand the potential implications of the ISCHEMIA trial on the appropriateness of PCI in a contemporary cohort of patients with SIHD.

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