Additive prognostic value of functional performance to coronary artery anatomy: the ISCHEMIA trial
Primary result · All-cause deathResult — go to the resultHazard ratio 0.86 95% CI 0.76–0.98Authors' conclusion
Peak METs on EST, a marker of functional performance, added prognostic value to models including CCTA anatomical findings in patients with CCD and moderate or severe ischaemia.
Study context
- Population
- Patients with chronic coronary disease (CCD) and moderate or severe ischaemia who underwent EST and coronary computed tomography angiography (CCTA)EST and the number of vessels diseased on CCTA both interpretable
- Participants
- 1,864 patients
- Comparison
- Addition of peak metabolic equivalents (METs) on EST to CCTA anatomical models
- Primary endpoint
- All-cause death
- Follow-up
- Median 3.1 years
Methodological detailscore laboratories, blinded to clinical data and results of the other tests
- Core laboratories, blinded to clinical data and results of the other tests
Primary result
As reported in the abstract
Hazard ratio
0.86
95% CI 0.76–0.98
P = 0.025
Higher peak METs
HR 0.86 (95% CI 0.76–0.98); P = 0.025
- Patients who died
- 69
- Improvement in predictive ability of all-cause death model by adding peak METs to coronary artery disease (CAD) severity
- 10-20%
Secondary outcomes
CV death
- Improvement in predictive ability by adding peak METs to CAD severity
- 8-13%
- Depending on the metrics used for CCTA
Myocardial infarction (MI)
- Better prediction by adding peak METs to CCTA anatomical models
- 11-17%
Cardiovascular death or MI
- Better prediction by adding peak METs to CCTA anatomical models
- 10-14%
5-component composite outcome
- Better prediction by adding peak METs to CCTA anatomical models
- 12-16%
Original publication
Additive prognostic value of functional performance to coronary artery anatomy: the ISCHEMIA trial. Eur Heart J Cardiovasc Imaging. Published 4 February 2026. doi:10.
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