Health status relationship to ischemia and coronary artery disease severity in the ISCHEMIA trial.
Lawrence M Phillips, Philip G Jones, Leslee J Shaw et al.
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In 30 seconds
This secondary analysis of the multicentre randomised ISCHEMIA trial examined whether core-laboratory ischemia severity and coronary artery disease (CAD) severity on coronary CT angiography were associated with 1-year health status. Among 4,558 participants with baseline and 1-year assessments, 2,936 had baseline angina. In this subgroup, severe ischemia was associated with more frequent angina but also with higher adjusted odds of better 1-year Seattle Angina Questionnaire Summary Score than less ischemia (adjusted odds ratio 1.29, 95% CI 1.05-1.59, P = .007). Health status did not differ by CAD severity or by ischemia or CAD severity among asymptomatic participants.
Key findings
- Among participants with baseline angina, severe ischemia was associated with more frequent baseline angina (SAQ AF, 70.6 vs 73.0, P = .029).
- Severe versus less baseline ischemia was associated with better adjusted odds of 1-year overall health status (adjusted odds ratio 1.29, 95% CI 1.05-1.59, P = .007).
- One-year health status did not differ by CAD severity, or by ischemia or CAD severity among asymptomatic participants.
Why it matters
The findings show that ischemia severity and anatomic CAD severity do not map uniformly onto patient-reported health status. In participants with angina, severe ischemia was linked to more frequent angina yet better overall health status at 1 year. This distinction may help clinicians interpret symptom burden and health-status measures alongside test findings, rather than assuming that greater anatomic disease severity predicts worse reported health.
What to keep in mind
This was a secondary analysis, and the reported associations do not establish that ischemia severity caused differences in health status.