A long-term follow-up of the ISCHEMIA trial found that routine early procedures such as stenting or bypass surgery did not improve survival for people with stable coronary artery disease compared with medication and lifestyle changes.

The trial included more than 5,000 patients with stable disease and abnormal stress tests at 320 hospitals in 37 countries; both groups received cholesterol- and blood-pressure-lowering medicines and advice on diet and exercise.

After nearly a decade, estimated death rates were similar—26% among patients assigned to early invasive treatment and 27% among those assigned to conservative treatment—with 1,071 deaths recorded and outcomes assessed for up to 13 years.

Early procedures can ease chest pain and improve quality of life for some patients, but the findings show that symptom relief does not necessarily translate into longer survival.

The results concern stable, chronic coronary disease; procedures to open blocked arteries can still be lifesaving during a heart attack or a threatened heart attack.

Researchers said treatment choices should balance potential symptom and quality-of-life benefits against procedural risks, given the similar survival seen with modern medical treatment and healthy habits.

The follow-up did not track nonfatal heart attacks, repeat procedures or quality of life beyond the original trial period, limiting conclusions about those outcomes.

The findings were presented November 7 at the American Heart Association Scientific Sessions and published online in the Journal of the American Medical Association.