Impact of the ISCHEMIA trial on the role of noninvasive diagnostic pathways in patients with chronic coronary syndrome

Randomized trials represent the highest level of evidence informing guidelines; however, the uptake of new knowledge in clinical practice may vary. 1 Gelijns A.C. Gabriel S.E. Looking beyond translation--integrating clinical research with medical practice. N Engl J Med. 2012; 366: 1659-1661 Crossref Scopus (53) Google Scholar In cardiology, the ISCHEMIA trial compared invasive and conservative initial strategies for patients with chronic coronary syndrome (CCS) and moderate-to-severe ischemia, showing no significant benefit of invasive management. 2 Maron D.J. Hochman J.S. Reynolds H.R. et al. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med. 2020; 382: 1395-1407 Crossref PubMed Scopus (1128) Google Scholar Following the trial, coronary computed tomography angiography (CCTA) emerged as a first-line test in CCS and as a gatekeeper to invasive coronary angiography (ICA). 3 Al-Lamee R. Jacobs A.K. ISCHEMIA trial: was it worth the wait?. Circulation. 2020; 142: 517-519 Crossref Scopus (5) Google Scholar Although ISCHEMIA had high resonance, modifications of routine catheterization laboratory practice after ISCHEMIA have not been investigated to date. The aim of our study was to analyze whether the ISCHEMIA trial impacted on the diagnostic algorithm for CCS patients, supporting an increased uptake of CCTA over functional testing.