A companion study to ISCHEMIA focused on patients with both moderate-to-severe ischemia and advanced chronic kidney disease (CKD) or on dialysis (ESRD). Led by Sripal Bangalore, MD, interventional cardiologist and professor of medicine at NYU Langone, the ISCHEMIA-CKD trial randomized 777 patients to either an initial invasive strategy of optimal medical therapy (OMT) plus revascularization as appropriate, or an initial conservative strategy of OMT alone—with invasive therapy only for failure of medical therapy.

The results, presented at the 2019 American Heart Association meeting, showed that the invasive strategy did not demonstrate a reduction in the primary endpoint of death or nonfatal myocardial infarction. Nor did that approach significantly improve angina frequency or severity compared with OMT alone. The risk for stroke was increased more than threefold in the invasive versus the conservative group, although the risk of procedure-related stroke was low and similar between the groups. The combined endpoint of death or initiation of dialysis was significantly higher in patients treated invasively—though mortality was similar in both groups, indicating that new dialysis drove this difference.