Long-term follow-up from the ISCHEMIA trial found that routine early stenting or bypass surgery did not extend survival for people with stable coronary artery disease compared with medication and lifestyle changes.

Early procedures did relieve chest pain and improve quality of life during the initial trial period, but did not reduce serious heart problems or improve survival.

The findings apply to stable patients, not people having a heart attack or facing a threatened heart attack, when procedures to open blocked arteries can be lifesaving.

The analysis was a post hoc observational follow-up, not a new randomized trial, and included veterans with higher baseline health risks than the full trial population; some heart attacks were identified through health records.

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

Researchers said treatment choices should balance potential symptom relief and patients’ goals against procedural risks, given the similar survival with modern medical treatment and healthy habits; they are developing tools to tailor decisions to patients’ characteristics and symptoms.

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

The trial enrolled more than 5,000 patients with stable disease and abnormal stress tests at 320 hospitals in 37 countries; both treatment groups received cholesterol- and blood-pressure-management medication and counseling on diet and exercise.

After nearly a decade, estimated death rates were 26% among patients assigned to early invasive treatment and 27% among those assigned to conservative treatment, with 1,071 deaths recorded over follow-up of up to 13 years.