# ISCHEMIA (initial invasive or conservative strategy for stable coronary disease)

Study · id `cardio:ischemia-trial` · Cardiovascular Atlas · release `f6f6f1b6f50379ed` (public)

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Also called: ISCHEMIA; International Study of Comparative Health Effectiveness With Medical and Invasive Approaches

Browse, condition area: Coronary and vascular disease  

## In plain language

A large trial of 5179 people with stable coronary disease and moderate or severe ischemia. Half were assigned to an invasive strategy (a heart catheter test, then a stent or bypass surgery when possible, plus medicines) and half to medicines alone, with a catheter test only if medicines failed. After a median of 3.2 years the invasive strategy had not reduced heart events or death.

## Technical summary

Open-label randomized strategy trial (NCT01471522), 5179 participants enrolled, 2012-07 to 2019-06-30 primary completion, funded by the NHLBI among others. The abstract reports 318 primary events with the invasive strategy against 352 with the conservative strategy, a higher 6-month rate with the invasive strategy (5.3% against 3.4%) and a lower 5-year rate (16.4% against 18.2%, interval including zero), and says the findings depended on the definition of myocardial infarction. The registry names a study chair affiliated with New York University. The invasive arm covered PCI and coronary bypass, so the result is not about stents alone.

## Key facts

- Design: Allocation: randomized. Intervention model: parallel. Masking: none. Primary purpose: treatment. (Registry values, in lower case.)
- Phase: Not applicable
- Enrolled: 5179 participants (enrolled count; International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA), snapshot `cardio:ctgov-nct01471522-2026-10-14`, retrieved 2026-10-14)
- Started: 2012-07 (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA), snapshot `cardio:ctgov-nct01471522-2026-10-14`, retrieved 2026-10-14)
- Primary completion: 2019-06-30 (actual) (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA), snapshot `cardio:ctgov-nct01471522-2026-10-14`, retrieved 2026-10-14)
- Completion: 2023-05-30 (actual) (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA), snapshot `cardio:ctgov-nct01471522-2026-10-14`, retrieved 2026-10-14)
- Results first posted: 2020-07-23 (actual) (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA), snapshot `cardio:ctgov-nct01471522-2026-10-14`, retrieved 2026-10-14)
- Countries: United States; Argentina; Australia; Austria; Belgium; Brazil; Canada; China; Egypt; France; Germany; Hungary; India; Israel; Italy; Japan; Lithuania; Malaysia; Mexico; Netherlands; New Zealand; North Macedonia; Peru; Poland; Portugal; Romania; Russia; Saudi Arabia; Serbia; Singapore; South Africa; Spain; Sweden; Switzerland; Taiwan; Thailand; United Kingdom (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA), snapshot `cardio:ctgov-nct01471522-2026-10-14`, retrieved 2026-10-14)
- Care setting: Not reported
- Registry status: "COMPLETED" (U.S. National Library of Medicine (ClinicalTrials.gov), snapshot `cardio:ctgov-nct01471522-2026-10-14`, retrieved 2026-10-14)

## Connected pages

- Lists percutaneous coronary intervention among its procedures: Percutaneous coronary intervention (stents) (`cardio:pci`)
- Lists coronary artery disease as a condition: Coronary artery disease (`cardio:coronary-artery-disease`)
- Registry collaborator: National Heart, Lung, and Blood Institute (`cardio:nhlbi`)
- Main results, NEJM 2020: ISCHEMIA main results, NEJM 2020 (`cardio:pub-ischemia-nejm-2020`)

## Provenance

Content hash: 21ed5c8d63f419597af066711e90a62244fc8f791946c16fd028e9cf1f960097
Last substantive edit: 2026-10-15
Evidence last checked: 2026-10-14