NYU Langone: early stents or bypass in stable heart disease did not extend survival versus drugs alone
In the ISCHEMIA-EXTEND follow-up, the chance of death after nearly a decade was 26 percent with early procedures and 27 percent with drugs and lifestyle changes, the authors reported.
On 7 November 2026, a team led by NYU Langone Health presented results at the American Heart Association Scientific Sessions, published simultaneously in the Journal of the American Medical Association, according to EurekAlert. Patients with stable coronary artery disease and abnormal stress tests who had invasive procedures early in their care did not live longer than those treated initially with drugs and lifestyle changes alone eurekalert.org
EurekAlerteurekalert.orgOpen source ↗. After nearly a decade, the chance of death was 26 percent in the invasive group and 27 percent in the conservative group.
Design of ISCHEMIA-EXTEND
The study is a follow-up of the ISCHEMIA trial, which evaluated more than 5,000 men and women with stable coronary artery disease. In this condition, fatty buildup narrows arteries and limits blood flow but does not cause the sudden complete blockage seen in a heart attack. Patients were assessed at 320 hospitals in 37 countries in Europe, North America, Asia and the South Pacific.
All participants received drugs for cholesterol and blood pressure management, plus dietary and exercise counseling. One group also had heart procedures, such as stent implants or bypass surgery, soon after an abnormal stress test. The other group received such procedures only if symptoms worsened or a heart attack occurred.
Survival was tracked through direct contact and national health records. The study recorded 1,071 deaths up to 13 years after enrollment, and vital status was confirmed for 96 percent of participants eurekalert.org
EurekAlerteurekalert.orgOpen source ↗.
Results and limitations
The original ISCHEMIA results showed that starting with routine procedures eased symptoms and improved quality of life but did not reduce the rate of serious heart problems. Study co-lead author Judith S. Hochman said that early procedures help relieve chest pain and improve quality of life in people with chest pain, but are unlikely to help patients live longer.
The authors stress that the findings apply specifically to stable patients with chronic coronary disease. Procedures to open narrowed arteries or bypass a blockage are lifesaving for patients with heart attacks and threatened heart attacks, Hochman said.
Co-lead author Rebecca Anthopolos noted that the analysis did not track nonfatal heart attacks, repeat procedures, or quality of life beyond the initial trial period eurekalert.org
EurekAlerteurekalert.orgOpen source ↗. The team is now building tools to tailor decisions to individual patients by combining age, disease severity, heart and kidney function, and symptom burden with long-term survival data.
