Early Stents Fail To Extend Life In Stable Disease
ISCHEMIA-EXTEND followed more than 5,000 patients for up to 13 years: 26 percent died after an early invasive strategy, 27 percent after medicines first. The procedures relieve chest pain — the trial is careful about that — but in stable coronary disease, starting with pills doesn't cost years.
An abnormal stress test feels like a countdown. The longest follow-up ever run says it isn't one.
After nearly a decade, patients who got early stents were no more likely to be alive than patients who started with pills. [Early heart procedures do not improve long-term survival in stable heart disease]
ISCHEMIA-EXTEND followed more than 5,000 people with stable coronary disease for up to 13 years. Death rates were 26 percent with an early invasive strategy and 27 percent with medicines first — a one-point gap after 1,071 deaths, published in JAMA November 7. [Early heart procedures do not improve long-term survival in stable heart disease]
The trial underneath, ISCHEMIA, randomized patients with stable coronary artery disease and abnormal stress tests to two strategies: go in early — angiography, stents or bypass surgery, plus medication — or start with medication and lifestyle change, reserving procedures for when medical therapy failed. The original trial found no survival advantage to going in early. EXTEND, led by NYU Langone Health researchers and presented November 7 at the American Heart Association's Scientific Sessions, asked whether time reversed that answer. It didn't — and the follow-up is unusually complete, with vital status confirmed for 96 percent of participants as far as 13 years out. [Early heart procedures do not improve long-term survival in stable heart disease]
Read the headline numbers the way this desk insists: in absolute terms, 26 versus 27 percent is roughly one death's difference per hundred patients across a decade — a gap the trial reads as a tie, not a trend. What the invasive strategy did do, in the original trial, is relieve chest pain and improve quality of life for patients who had angina. And the finding has a fence around it: heart attacks and unstable disease are a different universe, where procedures save lives on a timer. This result governs one specific, very common moment — a stable patient, an abnormal stress test, no emergency — and it says the clock doesn't punish starting with medicine. [Early heart procedures do not improve long-term survival in stable heart disease]
The caveats are real. EXTEND didn't track nonfatal heart attacks, repeat procedures or quality of life beyond the initial trial period, so the symptom story after the first several years is untold here. But the question patients actually ask in that office — will going in now make me live longer — now has the longest and most complete answer cardiology has produced: no. Relief is a reason. Years aren't. [Early heart procedures do not improve long-term survival in stable heart disease]
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A little more perspective.
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