PATIENTS with chronic coronary disease who undergo an initial invasive strategy experience faster and greater improvement in angina compared to those treated conservatively, while unfavourable symptom patterns are more common with conservative management, according to new analysis of the ISCHEMIA trial.
Clinical trials often report outcomes at discrete time points, but the full picture of individual patients’ journeys is less clear. The ISCHEMIA trial previously demonstrated superior average health status at specific intervals following invasive treatment among those with baseline angina. This secondary analysis focused on symptoms over a two-year period, offering new insight into patterns of angina frequency for both initial invasive and initial conservative management approaches.
The study analysed 2,977 trial participants with chronic coronary disease and angina at baseline, dividing them into two groups: 1,505 undergoing an initial invasive strategy and 1,472 managed conservatively. Researchers identified six distinct symptom trajectories within each group, ranging from rapid or gradual resolution to persistent severe angina. In the invasive group, rapid resolution (27.1%) and early but persistent improvement (32.1%) were most common. Meanwhile, the conservative group showed a tendency for modest angina with minimal change (42.1%) and fewer cases of rapid resolution (12.8%) or early improvement (10.2%). Baseline characteristics were well balanced between groups.
Understanding these trajectories provides clinicians with valuable tools for identifying patients who may benefit from escalated therapy, particularly those with ongoing or severe symptoms. The study underscores the need for regular health status monitoring and a tailored approach rather than relying only on average outcomes or snapshot assessments. Long-term assessment of symptom patterns can lead to timely interventions and improved quality of life for patients with chronic coronary disease.
Reference
Ikemura N et al. Trajectories of angina after initial invasive vs conservative strategy for chronic coronary disease. Journal of the American College of Cardiology. 2025;86(11):782-93.
