![]() ![]() Louis, MO), and colleagues in their paper published online December 3, 2020, in Circulation. “In contrast to procedural MIs, spontaneous type 1 MIs were more strongly associated with an increased risk of death and were significantly reduced in patients randomized to the invasive strategy,” write lead author Bernard Chaitman, MD (Saint Louis School of Medicine, St. Type 1 MIs, or spontaneous infarctions, were significantly less frequent with the invasive revascularization strategy of PCI or CABG surgery regardless of the MI definition used in the trial, and these nonprocedural MIs were associated with worse prognosis. ![]() However, the difference between the treatment approaches was driven by a higher number of procedural MIs with the invasive strategy. When investigators analyzed events based on the secondary MI definition, which assessed PCI- and CABG-related infarctions using cTn levels as opposed to CK-MB, the conservative strategy of guideline-directed medical therapy was associated with a significantly lower risk of the study’s primary endpoint, a composite of cardiovascular death, MI, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest, and a lower risk of cardiovascular death or MI, which was a secondary endpoint. A new analysis of the ISCHEMIA trial reveals its results are highly contingent on how myocardial infarction is defined, with investigators reporting a significant treatment difference between the invasive and conservative strategies when counting MIs using the more-sensitive biomarker: cardiac troponin (cTn). ![]()
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