# ISCHEMIA-EXTEND: early invasive strategy did not change 11-year mortality in 5179 coronary patients

- Published: 2026-11-14 13:04 UTC
- Section: Life & Health › Medicine
- Tags: ISCHEMIA-EXTEND, chronic coronary disease, invasive strategy, conservative strategy, all-cause mortality, revascularization, coronary angiography, 11-year follow-up, guideline-directed medical therapy
- URL: https://realtech.media/news/rt-ae1f5b9b4214e9e4cbe3bdb3_ischemia_extend_early/

**In a long-term follow-up of the ISCHEMIA trial, 11-year all-cause mortality was 25.8% with routine invasive management and 26.9% with medical therapy alone; the difference was not significant.**

![ISCHEMIA-EXTEND: early invasive strategy did not change 11-year mortality in 5179 coronary patients](https://realtech.media/media/2026/11/dad5be70c6d19583.webp)
*science-et-vie.com*

Long-term follow-up results of ISCHEMIA, an international trial in chronic coronary disease, were published in JAMA. The trial randomized 5179 participants at 320 sites in 37 countries beginning August 2012, and follow-up continued through December 2025. All-cause mortality at 11 years did not differ significantly between an initial invasive strategy and an initial conservative strategy [1].

## Design and participants

Participants had chronic coronary disease with moderate or severe ischemia and a left ventricular ejection fraction of 35% or more. Patients with left main coronary artery disease, unacceptable angina or a recent acute coronary syndrome were not included. One group received guideline-directed medical therapy plus coronary angiography and revascularization when feasible. The other received guideline-directed medical therapy alone, with invasive management if medical therapy failed [1].

Median age was 64 years (IQR, 58-70); 23% of participants were female and 42% had diabetes. Median ejection fraction was 60% (IQR, 55%-65%). Data were analyzed by intention to treat, using cumulative incidence estimates, Cox and Fine-Gray models, bayesian analysis and restricted mean survival time [1].

## Mortality results

Median follow-up was 9 years (range, 1 day to 13.4 years). In total, 1071 deaths occurred, 782 of them during extended follow-up: 672 cardiovascular, 359 noncardiovascular and 40 unclassified [1].

All-cause mortality at 11 years was 25.8% in the invasive group and 26.9% in the conservative group (estimated difference, -1.0 percentage point; 95% CI, -4.2 to 2.1; adjusted hazard ratio, 0.97; 95% CI, 0.86-1.09). In the bayesian analysis, the posterior probability of a survival benefit of more than 1 percentage point for the invasive strategy was 18% [1].

Cardiovascular mortality at 11 years was 15.8% with the invasive strategy and 17.1% with the conservative one (adjusted hazard ratio, 0.88; 95% CI, 0.75-1.02). Noncardiovascular mortality was 9.1% and 8.1%, respectively (adjusted hazard ratio, 1.18; 95% CI, 0.96-1.45). Eleven-year restricted mean survival differed by 14 days (95% CI, -41 to 70 days), which was not significant [1].

The authors concluded that long-term all-cause mortality in patients with high-risk chronic coronary disease was not significantly different after routine invasive versus initial conservative management. The trial is registered at ClinicalTrials.gov, NCT04894877 [1].

## Sources

1. [JAMA](https://doi.org/10.1001/jama.2026.20375)
2. [science-et-vie.com](https://www.science-et-vie.com/corps-et-sante/les-chercheurs-ont-suivi-des-patients-cardiaques-pendant-plusieurs-annees-les-interventions-invasives-precoces-ne-leur-ont-pas-permis-de-vivre-plus-longtemps-266081.html)

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Source: RealTech, realtech.media — https://realtech.media/news/rt-ae1f5b9b4214e9e4cbe3bdb3_ischemia_extend_early/