{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T17:10:38Z","timestamp":1773335438808,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Capital Health Development Research Special Project","award":["2024-1-2061"],"award-info":[{"award-number":["2024-1-2061"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270345"],"award-info":[{"award-number":["82270345"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Beijing Medical Management Center: Yangfan Program","award":["YGLX202324"],"award-info":[{"award-number":["YGLX202324"]}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The ISCHEMIA trial demonstrated no overall prognostic benefit of an initial invasive strategy over optimal medical therapy (OMT) in patients with chronic coronary syndrome (CCS) and moderate-to-severe ischemia. However, managing patients with stable angina and low systolic blood pressure (SBP) remains challenging due to limited tolerance to vasodilatory anti-anginal drugs and the uncertain role of revascularization in improving long-term outcomes for this subgroup. Objectives: This study aimed to estimate the treatment effect of an initial invasive strategy (INV) compared with conservative medical therapy (CON) on long-term clinical outcomes and quality of life in patients with stable angina, particularly those with low baseline systolic blood pressure (\u2264120 mmHg). Methods: We conducted a post hoc analysis of 3544 patients with stable angina from the ISCHEMIA trial, divided into an initial invasive strategy or a conservative approach. The primary endpoint was a 3-year composite of cardiovascular death, myocardial infarction, hospitalization for unstable angina or heart failure, or resuscitated cardiac arrest. Health-related quality of life was assessed using the Seattle Angina Questionnaire (SAQ). In the subgroup, patients were stratified by baseline SBP, diastolic blood pressure (DBP) and heart rate; the Cox model was adjusted for the covariates. Results: Baseline characteristics were generally comparable between the two groups. Over 3 years of follow-up, no significant difference in primary endpoint events was observed between the INV and CON group in the overall cohort (HR = 0.94, 95%CI 0.77\u20131.14, p = 0.53), and the INV group had the higher SAQ score. Among patients with low baseline SBP (\u2264120 mmHg), after adjusting for clinical factors using Cox regression, randomized treatment assignment to the INV approach significantly reduced adverse cardiovascular events compared with conservative therapy (HR = 0.58, 95%CI 0.38 to 0.89). Conclusions: In patients with stable angina, an invasive strategy improved long-term quality of life. Among those with low baseline SBP (\u2264120 mmHg) and limited tolerance to vasodilatory anti-anginal drugs, invasive management reduced 3-year adverse events, supporting tailored revascularization strategies for these patients; a larger cohort is needed for validation. However, this subgroup-specific causal contrast derives from a post hoc exploratory analysis and should be interpreted cautiously; prospective randomized studies are needed to further validate these findings.<\/jats:p>","DOI":"10.3390\/jcm15062100","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:55:38Z","timestamp":1773136538000},"page":"2100","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Benefits of Invasive Strategy in Stable Angina Patients with Low Systolic Blood Pressure: A Post Hoc Analysis of the ISCHEMIA Trial"],"prefix":"10.3390","volume":"15","author":[{"given":"Yicong","family":"Ye","sequence":"first","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Lin","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengge","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Statistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaodong","family":"Ding","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1843-4117","authenticated-orcid":false,"given":"Yang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zehao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjie","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiliang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Zeng","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1056\/NEJMoa1915922","article-title":"Initial Invasive or Conservative Strategy for Stable Coronary Disease","volume":"382","author":"Maron","year":"2020","journal-title":"N. 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