{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T15:56:57Z","timestamp":1778083017851,"version":"3.51.4"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We analyzed participants\u2019 disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: &gt;5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions. The average effect of initial invasive versus conservative strategies on 1-year SAQ scores was estimated using Bayesian proportional odds regression and compared across regions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Considerable regional variation in baseline health status was observed among 4617 participants (mean age=64.4\u00b19.5 years, 24% women), with the mean SAQ summary scores of 67.4\u00b119.5 in Eastern Europe participants (17% of the total), 71.4\u00b115.4 in Asia-Pacific (18%), 74.9\u00b116.7 in Central and South America (10%), 75.5\u00b119.5 in Western Europe (26%), and 78.6\u00b119.2 in North America (28%). One-year improvements in SAQ scores were greater in regions with lower baseline scores with initial invasive management (17.7\u00b120.9 in Eastern Europe and 11.4\u00b119.3 in North America), but similar in the conservative arm. Adjusting for baseline SAQ scores, similar health status benefits of an initial invasive strategy on 1-year SAQ scores were observed (ranging from 2.38 points [95% CI, 0.04\u20134.50] in North America to 4.66 points [95% CI, 2.46\u20136.94] in Eastern Europe), with an 88.3% probability that the difference in benefit across regions was &lt;5 points.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>In patients with chronic coronary disease and moderate or severe ischemia, initial invasive management was associated with a consistent health status benefit across regions, with modest regional variability, supporting the international generalizability of health status benefits from invasive management of chronic coronary disease.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT01471522\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.123.010534","type":"journal-article","created":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T09:00:58Z","timestamp":1726822858000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["International Variation in Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights From the ISCHEMIA Trial"],"prefix":"10.1161","volume":"17","clinical-trial-number":[{"clinical-trial-number":"nct01471522","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6347-4460","authenticated-orcid":true,"given":"Nobuhiro","family":"Ikemura","sequence":"first","affiliation":[{"name":"University of Missouri-Kansas City\u2019s Healthcare Institute for Innovations in Quality and Saint Luke\u2019s Mid America Heart Institute, (N.I., J.A.S., D.N., Z.F., P.G.J.)."},{"name":"Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (N.I., S.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2839-2611","authenticated-orcid":true,"given":"John A.","family":"Spertus","sequence":"additional","affiliation":[{"name":"University of Missouri-Kansas City\u2019s Healthcare Institute for Innovations in Quality and Saint Luke\u2019s Mid America Heart Institute, (N.I., J.A.S., D.N., Z.F., P.G.J.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7025-4442","authenticated-orcid":true,"given":"Dan","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University of Missouri-Kansas City\u2019s Healthcare Institute for Innovations in Quality and Saint Luke\u2019s Mid America Heart Institute, (N.I., J.A.S., D.N., Z.F., P.G.J.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9190-195X","authenticated-orcid":true,"given":"Zhuxuan","family":"Fu","sequence":"additional","affiliation":[{"name":"University of Missouri-Kansas City\u2019s Healthcare Institute for Innovations in Quality and Saint Luke\u2019s Mid America Heart Institute, (N.I., J.A.S., D.N., Z.F., P.G.J.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7136-4464","authenticated-orcid":true,"given":"Philip G.","family":"Jones","sequence":"additional","affiliation":[{"name":"University of Missouri-Kansas City\u2019s Healthcare Institute for Innovations in Quality and Saint Luke\u2019s Mid America Heart Institute, (N.I., J.A.S., D.N., Z.F., P.G.J.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0284-0655","authenticated-orcid":true,"given":"Harmony R.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (H.R.R., S.B., J.S.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9485-0652","authenticated-orcid":true,"given":"Sripal","family":"Bangalore","sequence":"additional","affiliation":[{"name":"Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (H.R.R., S.B., J.S.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Balram","family":"Bhargava","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi (B.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6579-7039","authenticated-orcid":true,"given":"Roxy","family":"Senior","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, CA (F.R., D.J.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Elghamaz","sequence":"additional","affiliation":[{"name":"Northwick Park Hospital, London, United Kingdom (R.S., A.E.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8068-2440","authenticated-orcid":true,"given":"Shaun G.","family":"Goodman","sequence":"additional","affiliation":[{"name":"St Michael\u2019s Hospital, University of Toronto, Canada (S.G.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2999-4961","authenticated-orcid":true,"given":"Renato D.","family":"Lopes","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (R.D.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7519-0003","authenticated-orcid":true,"given":"Radoslaw","family":"Praco\u0144","sequence":"additional","affiliation":[{"name":"National Institute of Cardiology, Warsaw, Poland (R.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0871-9197","authenticated-orcid":true,"given":"Jos\u00e9","family":"L\u00f3pez-Send\u00f3n","sequence":"additional","affiliation":[{"name":"IdiPaz Research Institute and Hospital Universitario La Paz, Madrid, Spain (J.L.-S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2764-6779","authenticated-orcid":true,"given":"Aldo P.","family":"Maggioni","sequence":"additional","affiliation":[{"name":"Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Heart Care Foundation, Florence, Italy (A.P.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-2972","authenticated-orcid":true,"given":"Shun","family":"Kohsaka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (N.I., S.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8355-9146","authenticated-orcid":true,"given":"Gregory A.","family":"Roth","sequence":"additional","affiliation":[{"name":"Division of Cardiology, the University of Washington, Seattle (G.A.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7712-6750","authenticated-orcid":true,"given":"Harvey D.","family":"White","sequence":"additional","affiliation":[{"name":"Health New Zealand Te Whatu Ora, Te Toka Tumal, Green Lane Cardiovascular Services and University of Auckland, New Zealand (H.D.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7250-1662","authenticated-orcid":true,"given":"Kreton","family":"Mavromatis","sequence":"additional","affiliation":[{"name":"Atlanta VA Medical Center, GA (K.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7145-8084","authenticated-orcid":true,"given":"William E.","family":"Boden","sequence":"additional","affiliation":[{"name":"Veterans Affairs New England Healthcare System, Boston University School of Medicine, MA (W.E.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5226-0723","authenticated-orcid":true,"given":"Fatima","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, CA (F.R., D.J.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5889-5981","authenticated-orcid":true,"given":"Judith S.","family":"Hochman","sequence":"additional","affiliation":[{"name":"Cardiovascular Clinical Research Center, Leon H. 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