What is the ISCHEMIA Trial? 

  • An NHLBI-funded international comparative effectiveness trial 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 Trial? 

  • An international comparative effectiveness trial 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 Trial.  


  • 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 Trial 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 Trial 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 trial began. Click here to see the participants by country.

Upcoming ISCHEMIA Presentations

  • No upcoming presentations at this time.  

Recent ISCHEMIA Presentations from ACC.2023

  • International Comparisons of Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights from the ISCH. (Oral presentation by Dr. Nobuhiro Ikemura) Link

For more Presentations, please CLICK HERE.

Recent ISCHEMIA Publications

  • Newman JD, Anthopolos R, Ruggles KV, Cornwell M, Reynolds HR, Bangalore S, Mavromatis K, Held C, Wallentin L, Kullo IJ, McManus B, Newby LKK, Rosenberg Y, Hochman JS, Maron DJ, Berger  JS on behalf of the ISCHEMIA Biorepository Research Group. Biomarkers and cardiovascular events in patients with stable coronary disease in the ISCHEMIA Trials. American Heart Journal. December 2023. Link

  • Stone GW, Ali ZA, O’Brien SM, Rhodes G, Genereux P, Bangalore S, Mavromatis K, Horst J, Dressler O, Poh KK, Nath RK, Moorthy N, Witkowski A, Dwivedi SK, Bockeria O, Chen J, Smanio PEP, Picard MH, Chaitman BR, Berman DS, Shaw LJ, Boden WE, White HD, Fremes SE, Rosenberg Y, Reynolds HR, Spertus JA, Hochman JS, Maron DJ on behalf of the ISCHEMIA Research Group. Impact of Complete Revascularization in the ISCHEMIA Trial. Journal of the American College of Cardiology. 19 September 2023:1175 – 1188. Link

  • Davis EF, Crousillat DR, Peteiro J, Lopez-Sendon J, Senior R, Shapiro MD, Pellikka PA, Lyubarova R, Alfakih K, Abdul-Nour K, Anthopolos R, Xu Y, Kunichoff DM, Fleg JL, Spertus JA, Hochman J, Maron D, Picard MH, Reynolds HR on behalf of the CIAO-ISCHEMIA Research Group. Global Longitudinal Strain as Predictor of Inducible Ischemia in No Obstructive Coronary Artery Disease in the CIAO-ISCHEMIA Study. Journal of the American Society of Echocardiography. 15 September 2023. Link

  • Mavromatis K, Jones PG, Ali ZA, Stone GW, Rhodes GM, Bangalore S, O’Brien S, Genereux P, Horst J, Dressler O, Goodman S, Alexander K, Mathew A, Chen J, Bhargava B, Uxa A, Boden WE, Mark DB, Reynolds HR, Maron DJ, Hochman JS, Spertus JA on behalf of the ISCHEMIA Research Group. Complete Revascularization and Angina-Related Health Status in the ISCHEMIA Trial. Journal of the American College of Cardiology. 25 July 2023:295 – 313. Link

For more Publications, please CLICK HERE.