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Patients with stable heart disease and abnormal stress tests who have invasive procedures early in their care do not live longer than those initially treated with drugs and lifestyle changes alone, an international study shows.

The findings build on results from the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial, which evaluated more than 5,000 men and women with stable coronary artery disease. In this condition, fatty buildup narrows arteries and limits blood flow but does not cause the sudden complete blockage seen in a heart attack.

According to the results, starting treatment with routine heart procedures—such as stent implants or bypass surgery—combined with medications and behavioral changes eased symptoms and improved quality of life, although this approach did not reduce the rate of serious heart problems.

In the new follow-up study called ISCHEMIA-EXTEND, a team led by NYU Langone Health researchers examined whether the early routine procedures, combined with medications and lifestyle changes, improved long-term survival compared with a conservative approach of medications and lifestyle changes only, with procedures reserved for a failure of medical therapy.

The findings revealed that after nearly a decade, death rates were essentially the same: The invasive approach was associated with a 26% chance of death, versus 27% for the conservative approach.

"Our analyses make clear that while managing stable coronary artery disease with early heart procedures helps relieve chest pain and improves quality of life in those with chest pain, it is unlikely to help patients live longer," said study co-lead author and ISCHEMIA chair Judith S.

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