Causes of cardiovascular and noncardiovascular death in the ISCHEMIA trial - 28/04/22
, Karen P. Alexander, MD b, Zhen Huang, MS b, Sean M. O'Brien, PhD b, Bernard R. Chaitman, MD c, Gregg W. Stone, MD d, Jonathan D. Newman, MD, MPH e, William E. Boden, MD f, Aldo P. Maggioni, MD g, Philippe Gabriel Steg, MD h, Thomas B. Ferguson, MD i, Marcin Demkow, MD j, Jesus Peteiro, MD k, Gurpreet S. Wander, DM l, Denis C. Phaneuf, MD m, Mark A. De Belder, MD n, Rolf Doerr, MD o, Erick Alexanderson-Rosas, MD p, Carisi A. Polanczyk, MD, ScD q, Peter A. Henriksen, MBChB, PhD r, Dwayne S.G. Conway, MD s, Vicente Miro, MD, PhD t, Tali Sharir, MD u, Renato D. Lopes, MD, PhD b, James K. Min, MD v, Daniel S. Berman, MD w, Frank W. Rockhold, PhD b, Stephen Balter, PhD x, David Borrego, PhD y, Yves D. Rosenberg, MD, MPH z, Sripal Bangalore, MD, MHA e, Harmony R. Reynolds, MD e, Judith S. Hochman, MD e, David J. Maron, MD aaon behalf of the
ISCHEMIA Research Group
Riassunto |
Background |
The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial demonstrated no overall difference in the composite primary endpoint and the secondary endpoints of cardiovascular (CV) death/myocardial infarction or all-cause mortality between an initial invasive or conservative strategy among participants with chronic coronary disease and moderate or severe myocardial ischemia. Detailed cause-specific death analyses have not been reported.
Methods |
We compared overall and cause-specific death rates by treatment group using Cox models with adjustment for pre-specified baseline covariates. Cause of death was adjudicated by an independent Clinical Events Committee as CV, non-CV, and undetermined. We evaluated the association of risk factors and treatment strategy with cause of death.
Results |
Four-year cumulative incidence rates for CV death were similar between invasive and conservative strategies (2.6% vs 3.0%; hazard ratio [HR] 0.98; 95% CI [0.70-1.38]), but non-CV death rates were higher in the invasive strategy (3.3% vs 2.1%; HR 1.45 [1.00-2.09]). Overall, 13% of deaths were attributed to undetermined causes (38/289). Fewer undetermined deaths (0.6% vs 1.3%; HR 0.48 [0.24-0.95]) and more malignancy deaths (2.0% vs 0.8%; HR 2.11 [1.23-3.60]) occurred in the invasive strategy than in the conservative strategy.
Conclusions |
In International Study of Comparative Health Effectiveness with Medical and Invasive Approaches, all-cause and CV death rates were similar between treatment strategies. The observation of fewer undetermined deaths and more malignancy deaths in the invasive strategy remains unexplained. These findings should be interpreted with caution in the context of prior studies and the overall trial results.
Il testo completo di questo articolo è disponibile in PDF.Mappa
Vol 248
P. 72-83 - Giugno 2022 Ritorno al numero
Articolo precedente
- Distinct triglyceride-glucose trajectories are associated with different risks of incident cardiovascular disease in normal-weight adults
- Xue Tian, Yingting Zuo, Shuohua Chen, Xia Meng, Pan Chen, Yongjun Wang, Shouling Wu, Yanxia Luo, Anxin Wang
- Prognostic value of echocardiography for heart failure and death in adults with chronic kidney disease
- Jesse K. Fitzpatrick, Andrew P. Ambrosy, Rishi V. Parikh, Thida C. Tan, Nisha Bansal, Alan S. Go, CRIC Study Investigators,
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?