Coronary disease & ACSSecondary analysis
Guideline-Directed Medical Therapy and Outcomes in the ISCHEMIA Trial
- Secondary analysis of the ISCHEMIA randomised trial
- observational
- Bayesian joint modeling
Authors' conclusion
Among participants with CCD, early attainment and maintenance of GDMT goals, especially SBP, were associated with fewer cardiovascular events. Compared with no GDMT goals at target, having all 4 GDMT goals at target at baseline was associated with an absolute 16% fewer CV deaths and MIs.
Study context
- Population
- Participants with chronic coronary disease in the ISCHEMIA trial4,914 with complete baseline goal data
- Participants
- 5,179 participants
- Comparison
- Attainment vs non-attainment of guideline-directed medical therapy (GDMT) goals
- 0-1 goalsn = 386
- 2 goalsn = 2,073
- 3 goalsn = 1,843
- 4 goalsn = 612
- Primary endpoint
- Cardiovascular (CV) death or myocardial infarction (MI)
- Follow-up
- 4 years
Primary result
As reported in the abstract
CV death/MI
Absolute event reduction (95% CrI)
SBP goal attainmentCrI
−5.1%(−11.3% to −1.0%)
antiplatelet therapyCrI
−11.2%(−29.1% to 0.8%)
low-density lipoprotein cholesterol <70 mg/dLCrI
−2.0%(−6.0% to 2.4%)
not smokingCrI
−1.7%(−9.3% to 4.2%)
Relative risk (95% CrI)
lower SBP during follow-upper 10 mm Hg lower SBP; CrI; adjusted for other GDMT goals and baseline characteristics
0.90(0.82–0.98)
Per 10 mm Hg lower SBP, as printed
Original publication
Guideline-Directed Medical Therapy and Outcomes in the ISCHEMIA Trial. J Am Coll Cardiol. Published 1 April 2025. doi:10.1016/j.jacc.2025.01.028
Summarised from the published abstract; every number is checked against it