ISCHEMIA-EXTEND: early invasive care does not lengthen survival in stable coronary disease
A JAMA follow-up of the ISCHEMIA trial, presented 7 November 2026 at the American Heart Association Scientific Sessions, found that after nearly a decade patients with stable coronary disease had essentially the same chance of death with an early invasive strategy (about 26%) as with an initial conservative strategy (about 27%).
A long-term follow-up of the ISCHEMIA trial, called ISCHEMIA-EXTEND, was presented on 7 November 2026 at the American Heart Association Scientific Sessions and published the same day in JAMA. Led by researchers at NYU Langone Health, including Judith S. Hochman and Rebecca Anthopolos, with senior author David Maron of Stanford, it asked whether starting with routine heart procedures — stents or bypass, plus medicines and lifestyle changes — improves long-term survival versus medicines and lifestyle changes first, with procedures reserved if medical therapy fails.
Main findings
The original ISCHEMIA trial evaluated more than 5,000 men and women with stable coronary artery disease (narrowed arteries that limit blood flow but are not causing a sudden complete blockage). After nearly a decade, death rates were essentially the same: about a 26% chance of death with the invasive approach versus about 27% with the conservative approach, NYU Langone reported. Investigators recorded 1,071 deaths up to 13 years after participants entered the study and confirmed whether 96% of participants were alive or had died. Patients came from 320 hospitals in 37 countries. All received cholesterol and blood-pressure drugs plus diet and exercise counseling.
Study leaders said early procedures can ease chest pain and improve quality of life in people who have symptoms, but are unlikely to help this stable group live longer. They stressed that procedures remain lifesaving for heart attacks and threatened heart attacks.
Limits — not personal medical advice
This follow-up focused on all-cause survival in stable chronic coronary disease. The authors cautioned that the analysis did not track nonfatal heart attacks, repeat procedures or quality of life beyond the initial trial period. Findings do not apply to acute coronary syndromes. Funding included NIH grant R01HL149888. This is not personal medical advice — talk to your doctor about treatment choices for heart disease.
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