ISCHEMIA Trial - 5, 179 patients with stable ischaemic heart disease (SIHD) and moderate or severe ischemia on stress testing, over a median of 3.3 years, were randomized to an invasive strategy of routine cardiac catheterization followed by optimal revascularization with PCI or CABG surgery vs. a conservative strategy, with cardiac catheterization, if there was failure of optimal medical therapy. Results showed that the cumulative incidence of the primary endpoint – a composite of cardiovascular death, MI, resuscitated cardiac arrest, or hospitalization for unstable angina or heart failure – was 15.5 percent in the conservative group vs. 13.3 percent in the invasive group after 4 years. In addition, the cumulative incidence of the major secondary endpoint – cardiovascular death or MI – was 13.9 percent in the conservative group vs. 11.7 percent in the invasive group after 4 years. Hence, an invasive management strategy may not demonstrate a reduced risk vs. a conservative management strategy of optimal medical therapy in patients with stable ischemic heart disease (SIHD) and moderate or severe ischemia, according to results of the ISCHEMIA trial presented Nov. 16 during AHA 2019 in Philadelphia, PA. Meanwhile, in a separate ISCHEMIA quality of life outcomes analysis also presented during AHA 2019, they found "significant, durable improvements in angina control and quality of life with an invasive strategy if they had angina." However, in patients without angina, "an invasive strategy led to minimal symptom or quality of life benefits, " vs. a conservative strategy. They conclude that moving forward, "in patients with angina, shared decision-making should occur to align treatment with patients' goals and preferences."