{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:38:58Z","timestamp":1790419138951,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2020,11,3]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Whether an initial invasive strategy in patients with stable ischemic heart disease and at least moderate ischemia improves outcomes in the setting of a history of heart failure (HF) or left ventricular dysfunction (LVD) when ejection fraction is \u226535% but &lt;45% is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Among 5179 participants randomized into ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), all of whom had left ventricular ejection fraction (LVEF) \u226535%, we compared cardiovascular outcomes by treatment strategy in participants with a history of HF\/LVD at baseline versus those without HF\/LVD. Median follow-up was 3.2 years.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              There were 398 (7.7%) participants with HF\/LVD at baseline, of whom 177 had HF\/LVEF &gt;45%, 28 HF\/LVEF 35% to 45%, and 193 LVEF 35% to 45% but no history of HF. HF\/LVD was associated with more comorbidities at baseline, particularly previous myocardial infarction, stroke, and hypertension. Compared with patients without HF\/LVD, participants with HF\/LVD were more likely to experience a primary outcome composite of cardiovascular death, nonfatal myocardial infarction, or hospitalization for unstable angina, HF, or resuscitated cardiac arrest (4-year cumulative incidence rate, 22.7% versus 13.8%; cardiovascular death or myocardial infarction, 19.7% versus 12.3%; and all-cause death or HF, 15.0% versus 6.9%). Participants with HF\/LVD randomized to the invasive versus conservative strategy had a lower rate of the primary outcome (17.2% versus 29.3%; difference in 4-year event rate, \u221212.1% [95% CI, \u221222.6 to \u22121.6%]), whereas those without HF\/LVD did not (13.0% versus 14.6%; difference in 4-year event rate, \u22121.6% [95% CI, \u22123.8% to 0.7%];\n              <jats:italic>P<\/jats:italic>\n              interaction = 0.055). A similar differential effect was seen for the primary outcome, all-cause mortality, and cardiovascular mortality when invasive versus conservative strategy\u2013associated outcomes were analyzed with LVEF as a continuous variable for patients with and without previous HF.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>ISCHEMIA participants with stable ischemic heart disease and at least moderate ischemia with a history of HF or LVD were at increased risk for the primary outcome. In the small, high-risk subgroup with HF and LVEF 35% to 45%, an initial invasive approach was associated with better event-free survival. This result should be considered hypothesis-generating.<\/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\/circulationaha.120.050304","type":"journal-article","created":{"date-parts":[[2020,8,29]],"date-time":"2020-08-29T07:00:39Z","timestamp":1598684439000},"page":"1725-1735","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":118,"title":["Initial Invasive Versus Conservative Management of Stable Ischemic Heart Disease in Patients With a History of Heart Failure or Left Ventricular Dysfunction"],"prefix":"10.1161","volume":"142","clinical-trial-number":[{"clinical-trial-number":"nct01471522","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2999-4961","authenticated-orcid":true,"given":"Renato D.","family":"Lopes","sequence":"first","affiliation":[{"name":"Duke University Medical Center, Durham, NC (R.D.L., M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen P.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (K.P.A., S.R.S., F.W.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna R.","family":"Stevens","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (K.P.A., S.R.S., F.W.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0284-0655","authenticated-orcid":true,"given":"Harmony R.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"NYU Grossman School of Medicine, New York (H.R.R., J.S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg W.","family":"Stone","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, Cardiovascular Research Foundation, New York (G.W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ileana L.","family":"Pi\u00f1a","sequence":"additional","affiliation":[{"name":"Wayne State University\/Central Michigan University, Detroit (I.L.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3732-4765","authenticated-orcid":true,"given":"Frank W.","family":"Rockhold","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (K.P.A., S.R.S., F.W.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Elghamaz","sequence":"additional","affiliation":[{"name":"Northwick Park Hospital\u2013Royal Brompton Hospital, London, UK (A.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Luis","family":"Lopez-Sendon","sequence":"additional","affiliation":[{"name":"Hospital Universitario La Paz, IdiPaz, CIBER-CV, Madrid, Spain (J.L.L.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7427-3237","authenticated-orcid":true,"given":"Pedro S.","family":"Farsky","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia, S\u00e3o Paulo, Brazil (P.S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0540-3357","authenticated-orcid":true,"given":"Alexander M.","family":"Chernyavskiy","sequence":"additional","affiliation":[{"name":"E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Moscow, Russia (A.M.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Diaz","sequence":"additional","affiliation":[{"name":"CIUSSS-MCQ, University of Montreal, Campus Mauricie, Trois-Rivieres, Canada (A.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Phaneuf","sequence":"additional","affiliation":[{"name":"H\u00f4pital Pierre-Le Gardeur, Quebec, Canada (D.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"De Belder","sequence":"additional","affiliation":[{"name":"Barts Health NHS Trust, London, UK (M.A.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-tong","family":"Ma","sequence":"additional","affiliation":[{"name":"First Affiliated Hospital of Xinjiang Medical University, Urumqi, China (Y.-t.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis A.","family":"Guzman","sequence":"additional","affiliation":[{"name":"DAMIC Medical Institute, Cordoba, Argentina (L.A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Khouri","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Durham, NC (R.D.L., M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Sionis","sequence":"additional","affiliation":[{"name":"Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB\u2013Sant Pau, CIBER-CV, Universitat Aut\u00f2noma de Barcelona, Spain (A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek J.","family":"Hausenloy","sequence":"additional","affiliation":[{"name":"The Hatter Cardiovascular Institute, Institute of Cardiovascular Sciences, University College London, UK (D.J.H.)."},{"name":"Cardiovascular &amp; Metabolic Disorders Program, Duke\u2013National University of Singapore Medical School (D.J.H.)."},{"name":"National Heart Research Institute Singapore, National Heart Centre (D.J.H.)."},{"name":"Yong Loo Lin School of Medicine, National University Singapore (D.J.H.)."},{"name":"Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Doerr","sequence":"additional","affiliation":[{"name":"Praxisklinik Herz und Gefaesse, Dresden, Germany (R.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph B.","family":"Selvanayagam","sequence":"additional","affiliation":[{"name":"Flinders Medical Centre, Adelaide, Australia (J.B.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2764-6779","authenticated-orcid":true,"given":"Aldo Pietro","family":"Maggioni","sequence":"additional","affiliation":[{"name":"ANMCO Research Center, Florence, Italy (A.P.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5889-5981","authenticated-orcid":true,"given":"Judith S.","family":"Hochman","sequence":"additional","affiliation":[{"name":"NYU Grossman School of Medicine, New York (H.R.R., J.S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Maron","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, CA (D.J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2010.165"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000039105.49749.6f"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1100356"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfq230"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602001"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.882"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.01.024"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915922"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.04.011"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1908655"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1313731"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0805450"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.03.043"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw128"},{"key":"e_1_3_4_16_2","first-page":"1","article-title":"Cardiovascular survey methods.","volume":"56","author":"Rose GA","year":"1968","unstructured":"Rose, GA, Blackburn, H. Cardiovascular survey methods. Monogr Ser World Health Organ. 1968;56:1\u2013188.","journal-title":"Monogr Ser World Health Organ"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.048194"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa070829"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0805796"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1807365"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.021168"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.108.830091"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.092973"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(99)00451-9"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.119.313572"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acvd.2017.05.006"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.03.034"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9149(01)02345-1"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.05.019"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1406944"},{"key":"e_1_3_4_31_2","first-page":"534","article-title":"Nonparametric estimation of partial transition probabilities in multiple decrement models.","volume":"6","author":"Aalen O","year":"1978","unstructured":"Aalen, O. Nonparametric estimation of partial transition probabilities in multiple decrement models. Ann. Stat. 1978;6:534\u2013545.","journal-title":"Ann"}],"updated-by":[{"DOI":"10.1161\/cir.0000000000000927","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T00:00:00Z","timestamp":1602460800000}}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.120.050304","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:43:07Z","timestamp":1715586187000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.120.050304"}},"subtitle":["Insights From the ISCHEMIA Trial"],"short-title":[],"issued":{"date-parts":[[2020,11,3]]},"references-count":30,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2020,11,3]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.120.050304"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.120.050304","relation":{"correction":[{"id-type":"doi","id":"10.1161\/CIR.0000000000000927","asserted-by":"object"}]},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,3]]},"assertion":[{"value":"2020-07-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}