Table 1. Summary of relevant studies on CAD, their anatomic definitions, methods to assess myocardial ischemia, percentage of documented myocardial ischemia and main results.
| Article | N | Angiographic criteria | Ischemia assessment | Documented ischemia on stress tests (%) | Main findings |
|---|---|---|---|---|---|
| CASS (MT × CABG) | 780 | Lesions >70%, or 50–70% if left main CAD | Angina CCS-1 or 2 | No | No differences in survival in 6- and 10-year follow-up. No difference between 1, 2 or 3-vessel disease. Benefit for surgical treatment in patients with reduced ejection fraction and 3-vessel disease in 10-year follow-up |
| MASS II (MT × PCI × CABG) | 611 | Proximal 2 or 3 multivessel >70% | Typical angina or positive treadmill test | 45% | No differences in 5-year follow-up regarding death. CABG superior to MT and PCI regarding major cardiovascular events, especially due to lower rates of new coronary interventions |
| BARI-2D (MT × PCI or CABG) | 2,368 | ≥50% with a positive stress test or ≥70% with typical angina | Typical angina or positive treadmill test | – | No difference in the rates of death and major cardiovascular events between patients undergoing prompt revascularization and those undergoing medical therapy |
| COURAGE (MT × PCI) | 2,287 | >70% and ischemia on resting ECG or stress test, or >80% and typical angina | Typical angina or positive stress test (treadmill or pharmacologic) | 85% | No differences in the risk of death, myocardial infarction, or other major cardiovascular events between MT and PCI |
| FAME-II | 888 | >50% in ≥1 vessel with FFR of 0.80 or less | Typical angina and FFR measures | 100% | Lower rates of the primary composite end point of death, MI, or urgent revascularization at 5 years for PCI group, due to lower rates of revascularizations. No significant difference in death |
| Hachamovitch et al. | 10,627 | No angiographic criteria | Nuclear study (exercise or pharmacologic stress) | 33% | Revascularization compared with MT had greater survival benefit in patients with moderate to large amounts of inducible ischemia |
| Garzillo et al. | 535 | Proximal multivessel >70% | Exercise stress testing | 50% | Presence of documented ischemia was not associated with the occurrence of major adverse events or changes in ejection fraction |
| Vincenti et al. | 1,024 | No angiographic criteria | Stress perfusion CMR | 33% | An ischemia burden of >1.5 ischemic segments on stress-perfusion CMR was associated with composite endpoints |
| Gupta et al. | 439 | No angiographic criteria | Stress/rest PET | 28% | Documented ischemia was not associated with appropriate ICD shocks and sudden cardiac death in patients with LVEF <35% |
PET, positron-emission tomography; CAD, coronary artery disease; CASS, Coronary Artery Surgery Study; MT, medical therapy; CABG, coronary artery bypass grafting; MASS II, Medicine, Angioplasty, or Surgery Study II; PCI, percutaneous coronary interventions; COURAGE, Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; FAME, Fractional Flow Reserve versus Angiography; ECG, electrocardiogram; FFR, fractional flow reserve; CMR, cardiac magnetic resonance; ICD, implantable cardiac defibrillator; LVEF, left ventricular ejection fraction.