{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:48:36Z","timestamp":1793832516880,"version":"4.6.1"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012737","name":"Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012737","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To assess whether baseline functional performance assessed by exercise treadmill stress testing (EST) has additive value to coronary computed tomography angiography (CCTA) for risk stratification among patients with chronic coronary disease (CCD) and moderate or severe ischaemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We performed a subgroup analysis of the ISCHEMIA trial including participants who underwent EST and CCTA. EST data and severity of coronary artery disease (CAD) on CCTA were evaluated by core laboratories, blinded to clinical data and results of the other tests. The primary outcome for this analysis was all-cause death. Secondary outcomes were cardiovascular death, cardiovascular death or myocardial infarction (MI), MI and a composite of cardiovascular death, MI, or hospitalization for heart failure, unstable angina, or resuscitated cardiac arrest. EST and the number of vessels diseased on CCTA were both interpretable in 1864 patients (median age 62 years, IQR 55\u201368, 83% males). During a median follow-up of 3.1 years, 69 patients died. Higher peak metabolic equivalents (METs) achieved on the qualifying stress test was associated with lower all-cause death (HR 0.86, 95% CI 0.76\u20130.98; P = 0.025). The addition of peak METs to CAD severity improved the predictive ability of the all-cause death and CV death models by 10\u201320% and 8\u201313% respectively, depending on the metrics used for CCTA. Adding peak METs to CCTA anatomical models resulted in better prediction of MI by 11\u201317%, cardiovascular death or MI by 10\u201314%, and 5-component composite outcome by 12\u201316%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeag032","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T12:38:10Z","timestamp":1770122290000},"page":"952-966","source":"Crossref","is-referenced-by-count":2,"title":["Additive prognostic value of functional performance to coronary artery anatomy: the ISCHEMIA trial"],"prefix":"10.1093","volume":"27","author":[{"given":"Sagit","family":"Ben Zekry","sequence":"first","affiliation":[{"name":"Non-invasive Cardiology Unit, Leviev Heart Center, Sheba Medical Center and Tel Aviv University , Tel Aviv ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-8887","authenticated-orcid":false,"given":"Georgios","family":"Tzimas","sequence":"additional","affiliation":[{"name":"Department of Medicine and Radiology, University of British Columbia , Vancouver, St. Paul's Hospital, 1081 Burrard Street Vancouver, BC, V6Z 1Y6 ,","place":["Canada"]},{"name":"Service of Cardiology, Lausanne University Hospital and University of Lausanne , Lausanne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3892-9029","authenticated-orcid":false,"given":"Jonathon","family":"Leipsic","sequence":"additional","affiliation":[{"name":"Department of Medicine and Radiology, University of British Columbia , Vancouver, St. Paul's Hospital, 1081 Burrard Street Vancouver, BC, V6Z 1Y6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Broderick","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G B John","family":"Mancini","sequence":"additional","affiliation":[{"name":"Department of Medicine and Radiology, University of British Columbia , Vancouver, St. Paul's Hospital, 1081 Burrard Street Vancouver, BC, V6Z 1Y6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron J","family":"Hague","sequence":"additional","affiliation":[{"name":"Department of Medicine and Radiology, University of British Columbia , Vancouver, St. Paul's Hospital, 1081 Burrard Street Vancouver, BC, V6Z 1Y6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Budoff","sequence":"additional","affiliation":[{"name":"Department of Medicine and Division of Cardiology, Lundquist Institute , Los Angeles, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K","family":"Min","sequence":"additional","affiliation":[{"name":"Cleerly Inc. , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9216-5317","authenticated-orcid":false,"given":"Bernard R","family":"Chaitman","sequence":"additional","affiliation":[{"name":"St. Louis University School of Medicine, Center for Comprehensive Cardiovascular Care , St. Louis, MO ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank W","family":"Rockhold","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Cyr","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslee J","family":"Shaw","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Icahn School of Medicine at Mount Sinai , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S","family":"Berman","sequence":"additional","affiliation":[{"name":"Departments of Imaging and Cardiology, Cedars-Sinai Medical Center , Los Angeles, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9264-3243","authenticated-orcid":false,"given":"Michael H","family":"Picard","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division, Massachusetts General Hospital , Boston, MA ,","place":["USA"]},{"name":"Department of Medicine, Cardiovascular Division, Harvard Medical School , Cambridge, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6340-8087","authenticated-orcid":false,"given":"Daniel B","family":"Mark","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome L","family":"Fleg","sequence":"additional","affiliation":[{"name":"National Heart Lung and Blood Institute , Bethesda, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kian Keong","family":"Poh","sequence":"additional","affiliation":[{"name":"National University Heart Center Singapore , Singapore ,","place":["Singapore"]},{"name":"Yong Loo Lin School of Medicine, National University of Singapore , Singapore ,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziad A","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St. Francis Hospital , New York, NY ,","place":["USA"]},{"name":"Cardiovascular Research Foundation , NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3416-8210","authenticated-orcid":false,"given":"Gregg W","family":"Stone","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Icahn School of Medicine at Mount Sinai , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean M","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5889-5981","authenticated-orcid":false,"given":"Judith S","family":"Hochman","sequence":"additional","affiliation":[{"name":"Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Clinical Research Center, NYU Grossman School of Medicine , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4867-8588","authenticated-orcid":false,"given":"David J","family":"Maron","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University , Stanford, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0284-0655","authenticated-orcid":false,"given":"Harmony R","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Leon H. 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