Health status after invasive or conservative care in coronary and advanced kidney disease
Open accessAbstract
BACKGROUND: 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.).
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The strong correlation between LEAD and diabetes is well established.
“The strong correlation between LEAD and diabetes is well established.[747][748][749]”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [748]
Diabetes is one of the most important risk factors for the development and progression of atherosclerosis.
“Diabetes is one of the most important risk factors for the development and progression of atherosclerosis.[747][748][749][750][751]”
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Massy, Z. A. (2026) · Kidney International · doi:10.1016/j.kint.2025.09.036 · Cited by 1 · see citing works
What is the Real Message of the ISCHEMIA Trial from a Clinician’s Perspective?
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Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2020
Wingo, M. T., Huber, J. M., Szostek, J. H., Bornstein, S. L., Post, J. A., Mauck, K. F., & Wieland, M. L. (2021) · The American Journal of Medicine · doi:10.1016/j.amjmed.2021.01.039 · Cited by 1 · see citing works
Perkutane koronare Revaskularisation beim chronischen Koronarsyndrom: wann sinnvoll, wann nicht?
Jakob, P., Holy, E. W., Siegrist, P. T., Michel, J., Manka, R., Kasel, M., Maier, W., Ruschitzka, F. T., Templin, C., & Stähli, B. E. (2021) · Praxis · doi:10.1024/1661-8157/a003648 · Cited by 1 · see citing works
Evaluation and replacement of renal function: history, advancement, and challenges
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No benefit of initial invasive strategy for managing CAD in advanced CKD
Fernández-Ruíz, I. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-0384-x
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Self-citationInvasive Versus Conservative Management of Stable Coronary Artery Disease in CKD
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Neue Daten zur Therapie der koronaren Herzkrankheit bei chronisch nierenkranken Patienten
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La revascularisation du patient coronarien stable
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Screening for Cardiovascular Disease in CKD: CON
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ISCHEMIA (stabile KHK): Prognose gleich, aber Symptome besser bei invasivem Vorgehen
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Nuclear cardiology and detection of coronary artery disease
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Percutaneous coronary intervention from COURAGE to ISCHEMIA and beyond
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Evaluation of the Transplant Recipient
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Interdisziplinäre Betreuung von Patienten mit Diabetes und Nierenerkrankungen
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Evaluation of the Transplant Recipient
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Coronary CT angiography for guiding PCI—Or no revascularization at all
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Chronic Kidney Disease in Cardiovascular Pathologies
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Kardiovaskuläre Erkrankungen bei chronischer Nierenerkrankung
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- Authors
- Spertus, J. A., Jones, P. G., Maron, D. J., Mark, D. B., O’Brien, S. M., Fleg, J. L., Reynolds, H. R., Stone, G. W., Sidhu, M. S., Chaitman, B. R., Chertow, G. M., Hochman, J. S., & Bangalore, S.
- Affiliations
- National Institutes of Health (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-04-23
- Volume
- 382
- Issue
- 17
- Pages
- 1619-1628
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC7255621
- OpenAlex
- W3013686145
- Cited by
- 84
- References
- 30
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 4 · 2023: 10 · 2022: 13 · 2021: 24 · 2020: 16 · 2019: 1
- FWCI
- 14.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (U01HL117904, U01HL117905)
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- stable coronary artery disease, advanced chronic kidney disease, angina pectoris, Seattle Angina Questionnaire, invasive strategy, conservative strategy, percutaneous coronary intervention, coronary angiography, quality of life, health status
- MeSH terms
- Healthy Lifestyle, Aged, Coronary Artery Bypass, Exercise Test, Female, Follow-Up Studies, Health Status, Humans, Male, Middle Aged, Surveys and Questionnaires, Proportional Hazards Models, Odds Ratio, Coronary Angiography, Myocardial Ischemia, Renal Insufficiency, Chronic, Intention to Treat Analysis, Percutaneous Coronary Intervention
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