Causes of cardiovascular and non-cardiovascular death in the ISCHEMIA trial
American Heart Journal Feb 11, 2022
Among participants from the ISCHEMIA trial, cause-specific death rates were analyzed and findings revealed similar all-cause and cardiovascular (CV) death rates between treatment strategies. The invasive strategy was associated with fewer undetermined deaths and more malignancy deaths; this observation remains unexplained. These results need to be interpreted with caution in the context of previous studies and the overall trial findings.
In the ISCHEMIA trial, the composite primary endpoint and the secondary endpoints of CV death/myocardial infarction or all-cause mortality did not differ overall between an initial invasive or conservative strategy among patients with chronic coronary disease and moderate or severe myocardial ischemia.
For deaths attributable to CV conditions, the 4-year cumulative incidence rates were found to be similar between invasive and conservative strategies [2.6% vs 3.0%; hazard ratio (HR) 0.98], but non-CV death rates were higher in the invasive strategy [3.3% vs 2.1%; HR 1.45].
Deaths due to undetermined causes (38/289) comprised 13% of the overall deaths.
In the invasive strategy arm, fewer undetermined deaths [0.6% vs 1.3%; HR 0.48] and more malignancy deaths [2.0% vs 0.8%; HR 2.11] occurred when compared to the conservative strategy.
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