What is the ISCHEMIA Study? 

  • An NHLBI-funded international comparative effectiveness study to determine the best way to treat chronic coronary disease.
  • Patients with moderate or severe ischemia, with or without stress imaging, were eligible for participation.

What is the ISCHEMIA-CKD Study? 

  • An international comparative effectiveness study to determine the best way to manage chronic coronary disease in patients with advanced chronic kidney disease (eGFR <30 or on dialysis).
  • Patients with advanced CKD with moderate to severe ischemia on stress testing were randomized to this Study.  


  • ISCHEMIA-EXTEND is the long-term follow-up of randomized, surviving participants in the ISCHEMIA and ISCHEMIA-CKD trials.
  • ISCHEMIA-EXTEND assesses whether an initial invasive strategy—cardiac catheterization and revascularization when feasible plus optimal medical therapy (OMT)—reduces long-term all-cause mortality as compared with an initial conservative strategy of OMT for chronic coronary disease patients with moderate or severe ischemia over an extended 5 year period of follow-up.

Why is the ISCHEMIA Study Important?

  • Chronic coronary disease is the leading cause of death and disability worldwide and affects an estimated 18,200,000 Americans, resulting in about 541,000 deaths in the United States annually. Globally, 8.9 million deaths are caused by IHD each year. Medical therapy (medication and lifestyle changes) should always be used to treat IHD. The trial showed that heart procedures added to taking medicines and making lifestyle changes did not reduce the overall rate of cardiovascular death and heart attack compared with medicines and lifestyle changes alone. However, for people with chest pain symptoms, heart procedures improved symptoms better than medicines and lifestyle changes alone. The more chest pain to begin with, the more symptoms improved after getting a stent or bypass surgery.
  • For ISCHEMIA Study Results, please click here.

Why is ISCHEMIA-EXTEND Important?

  • The ISCHEMIA and ISCHEMIA-CKD trials did not demonstrate a reduction in their primary endpoints with an initial invasive strategy. All-cause mortality was similar over 5 years. There was an early excess of peri-procedural MI and a late reduction in spontaneous MI in both trials. Prior evidence demonstrates that spontaneous MI has a larger impact on subsequent death than most peri-procedural MI’s. Therefore, it is imperative to assess long-term all-cause mortality to provide patients and clinicians with robust evidence regarding survival following the two initial management strategies over the long-term (~10 years).
  • Understanding the impact of nonfatal events on subsequent mortality among patients with chronic coronary disease will influence clinical practice and the design of cardiovascular clinical trials for years to come. With the ever-increasing sensitivity of biomarker assays for MI, it is of paramount importance to understand the relationship between MI and subsequent death.

Total Number of Participants in ISCHEMIA-EXTEND:

  • Over 5,000 participants worldwide entered ISCHEMIA-EXTEND when this follow-up study began. Click here to see the participants by country.

Upcoming ISCHEMIA Presentations at AHA 2022

  • Please click HERE to view the upcoming schedule for AHA 2022, taking place November 5-7th in Chicago, IL and virtually. 

Recent ISCHEMIA Presentations from ESC.2022

  • ISCHEMIA-CKD EXTEND Follow-Up: Clinical Outcomes at 5 years of Follow-Up EXTEND-CKD (Presented by Dr. Sripal Bangalore)
  • Factors Associated with Early Catheterization in Patients Randomized to the Conservative Strategy in the ISCHEMIA Trial (Presented by Dr. Radoslav Pracon) (Link)

For more Presentations, please CLICK HERE.

Recent ISCHEMIA Publications

  • Garcia RA, Spertus JA, Benton MC, Jones PG, Mark DB, Newman JD, Bangalore S, Boden WE, Stone GW, Reynolds HR, Hochman JS, Maron DJ; ISCHEMIA Research Group. Association of Medication Adherence With Health Outcomes in the ISCHEMIA Trial. J Am Coll Cardiol. 2022 Aug 23;80(8):755-765. doi: 10.1016/j.jacc.2022.05.045. PMID: 35981820. Link.
  • Chaitman BR, Cyr DD, Alexander KP, Pracoń R, Bainey KR, Mathew A, Acharya A, Kunichoff DF, Fleg JL, Lopes RD, Sidhu MS, Anthopolos R, Rockhold FW, Stone GW, Maron DJ, Hochman JS, Bangalore S. Cardiovascular and Renal Implications of Myocardial Infarction in the ISCHEMIA-CKD Trial. Circ Cardiovasc Interv. 2022 Aug;15(8):e012103. doi: 10.1161/CIRCINTERVENTIONS.122.012103. Epub 2022 Aug 16. PMID: 35973009. Link.
  • Rodriguez F, Hochman JS, Xu Y, Reynolds HR, Berger JS, Mavromichalis S, Newman JD, Bangalore S, Maron DJ. Screening for participants in the ISCHEMIA trial: Implications for clinical research. J Clin Transl Sci. 2022 Jul 13;6(1):e90. doi: 10.1017/cts.2022.428. PMID: 36003207; PMCID: PMC9389278. Link.
  • Bangalore S, Hochman JS, Stevens SR, Jones PG, Spertus JA, O'Brien SM, Reynolds HR, Boden WE, Fleg JL, Williams DO, Stone GW, Sidhu MS, Mathew RO, Chertow GM, Maron DJ. Clinical and Quality-of-Life Outcomes Following Invasive vs Conservative Treatment of Patients With Chronic Coronary Disease Across the Spectrum of Kidney Function. JAMA Cardiol. 2022 Aug 1;7(8):825-835. doi: 10.1001/jamacardio.2022.1763. PMID: 35767253; PMCID: PMC9244774. Link.
  • Sidhu MS, Alexander KP, Huang Z, O'Brien SM, Chaitman BR, Stone GW, Newman JD, Boden WE, Maggioni AP, Steg PG, Ferguson TB, Demkow M, Peteiro J, Wander GS, Phaneuf DC, De Belder MA, Doerr R, Alexanderson-Rosas E, Polanczyk CA, Henriksen PA, Conway DSG, Miro V, Sharir T, Lopes RD, Min JK, Berman DS, Rockhold FW, Balter S, Borrego D, Rosenberg YD, Bangalore S, Reynolds HR, Hochman JS, Maron DJ. Causes of Cardiovascular and Non-Cardiovascular Death in the ISCHEMIA Trial. American Heart Journal. June 2022. Link

For more Publications, please CLICK HERE.