The Landmark ISCHEMIA Study
By John Gordon Harold,
MD, MACC, MACP, FESC, FRCPI, FRCP (London), FCSI, FCCP, FAHA
Past President of the American College of Cardiology (ACC) and the national chair of ACC’s Campaign for the Future.
The most significant change in the cardiovascular space for 2019 was the release of the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches: Primary Report of Clinical Outcomes) trial at the AHA Scientific Sessions in Philadelphia.
I was in the standing room audience at the Philadelphia Convention Center Main Arena on November 16, 2019 when Dr. Judith Hochman presented the results of this pivotal paradigm changing trial. The ISCHEMIA trial failed to show that routine invasive therapy was associated with a reduction in major adverse ischemic events compared with optimal medical therapy among stable patients with moderate ischemia.
The hard endpoints of myocardial infarction, cardiovascular death, and all-cause death also did not differ between the treatment arms. Routine invasive therapy was associated with increase in periprocedural myocardial infarctions and associated with benefit at four years with reduction in spontaneous myocardial infarction.
These results did not apply to patients with current/recent acute coronary syndrome, highly symptomatic patients, left main stenosis, or left ventricular ejection fraction <35%.
This landmark study will change the practice of cardiology and provides patients an important new way to understand atherosclerotic heart disease. The trial results should lead to a greater focus on shared decision making by identifying the best diagnostic and treatment options for the individual patient by considering multiple different factors and importantly patient preference.
The ISCHEMIA landmark study will change the practice of cardiology and provides patients an important new way to understand atherosclerotic heart disease.
John Gordon Harold,
MD, MACC, MACP, FRCPI, FRCP, FESC, FCSI, FCCP, FAHA
Dr. Harold, board certified in internal medicine, cardiovascular disease, geriatric medicine and critical care medicine, is a past chief of staff at Cedars-Sinai Medical Center in Los Angeles. He currently serves as clinical professor of medicine at the Cedars-Sinai Smidt Heart Institute and the David Geffen School of Medicine at the University of California at Los Angeles (UCLA). Dr. Harold is a member of the Cedars-Sinai Medical Center voluntary clinical faculty and is an attending physician at the Cedars-Sinai Smidt Heart Institute.
Dr. Harold is a past president of the American College of Cardiology (ACC). He is a past chair of the ACC Board of Governors and previously served as ACC Secretary. Dr. Harold is the Editor-in-Chief of ACC’s Cardiology Magazine.
Dr. Harold was the architect of ACC’s digital strategy and International Twinning Program. He was responsible for twinning the British Cardiovascular Society with the ACC California Chapter and helped to champion ACC’s international strategy. These innovative programs have now evolved into ACC’s Chapter Exchange Program which involves multiple ACC State Chapters and global cardiac societies. Dr. Harold has been active in global advocacy and served as Chair of the World Heart Federation Partner’s Council in 2016 and was a member of the Board of Directors of the World Heart Federation. He represents the ACC at the World Heart Federation Scientific Policy and Advocacy Committee (SPAC). He currently sits on the ACC Governance Committee.
Dr. Harold has represented the ACC at numerous events sponsored by the World Health Organization in Geneva and New York and testified for the ACC at the United Nations General Assembly hearing on noncommunicable diseases (NCDs). He is a member of the Board of Directors of numerous organizations, including the Los Angeles affiliate of the American Heart Association, the Heart Fund at Cedars-Sinai and the UCLA Clinical Faculty Association. He is the current President of the Los Angeles County Affiliate of the American Heart Association.
Dr. Harold is a former member of the American Board of Internal Medicine (ABIM) Board of Directors and ABIM Executive Committee. He currently serves on the ABIM Foundation Board of Trustees.
Dr. Harold completed his internal medicine training at Mount Sinai Hospital in New York and a fellowship in cardiology at Cedars-Sinai Medical Center in Los Angeles. He was honored with the Master designation from both the American College of Physicians and the American College of Cardiology. Dr. Harold holds honorary fellowships with the Royal College of Physicians of Ireland, Royal College of Physicians of London, the InterAmerican Heart Foundation and the Cardiological Society of India.
Dr. Harold holds board certification from the American Board of Internal Medicine in Internal Medicine, Cardiovascular Diseases, Critical Care Medicine and Geriatrics.
He is married to Ellen Teresa Harold, RN.