New York, New York, USA, November 7, 2026
NYU Grossman School of Medicine and NYU Langone Health have reported important findings from a long-term cardiovascular research study showing that routine invasive heart procedures do not provide a significant long-term survival advantage over medication-based treatment in patients with stable coronary artery disease (CAD). The findings come from the ISCHEMIA-EXTEND study, an extended follow-up investigation of participants enrolled in the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial. The research examined whether performing procedures such as coronary stenting and bypass surgery early in treatment, alongside medications and lifestyle modifications, could improve long-term survival compared with an initially conservative treatment strategy. The results showed that patients receiving early invasive treatment had broadly similar survival outcomes to those receiving medical therapy, with invasive procedures reserved for situations in which medical management was insufficient. The findings were presented on November 7, 2026, during the American Heart Association (AHA) Scientific Sessions 2026 and simultaneously published online in the Journal of the American Medical Association (JAMA). The research provides additional evidence to support individualized cardiovascular treatment decisions and highlights the importance of evaluating the long-term benefits and potential risks of invasive interventions.
ISCHEMIA-EXTEND Study Evaluates Two Treatment Approaches
The ISCHEMIA-EXTEND investigation followed 5,179 participants with stable coronary artery disease who had moderate or severe ischemia. The original clinical trial included patients treated at 320 hospitals across 37 countries, making it a major international investigation into cardiovascular treatment strategies. Participants were assigned to one of two approaches. The first group received an initial invasive strategy involving coronary angiography and, when appropriate, revascularization through procedures such as balloon angioplasty, stent implantation or coronary artery bypass grafting, alongside guideline-directed medical therapy. The second group initially received medical treatment and lifestyle interventions, with invasive procedures reserved for patients whose symptoms worsened or whose condition required additional intervention. Both groups received medications to manage cholesterol and blood pressure, together with dietary guidance and exercise recommendations. Researchers evaluated long-term survival outcomes using patient follow-up and national health records. During the extended observation period, the study recorded 1,071 deaths, providing substantial information about the long-term outcomes associated with both treatment strategies. The findings demonstrated that routine early intervention did not significantly improve overall survival compared with an initial conservative management approach.
Survival Outcomes Remain Similar Between Treatment Groups
The long-term analysis found that estimated 11-year all-cause mortality was 25.8% in the invasive treatment group compared with 26.9% in the conservative treatment group. Statistical analysis did not demonstrate a significant survival difference between the approaches. The results suggest that routinely performing invasive procedures in patients with stable coronary artery disease does not necessarily translate into longer life expectancy when compared with appropriate medical management. However, researchers emphasized that invasive procedures can provide meaningful benefits for patients experiencing chest pain, particularly by reducing angina symptoms and improving quality of life. These benefits should be considered separately from long-term survival outcomes. Coronary artery disease develops when fatty deposits accumulate within the coronary arteries, restricting blood flow to the heart muscle. Invasive procedures can help restore blood flow through narrowed vessels, but the decision to perform them depends on several factors, including symptoms, disease severity, overall cardiovascular health and the patient’s response to medication. Importantly, the study findings apply to stable coronary artery disease and should not be generalized to patients experiencing acute heart attacks or threatened heart attacks, where emergency procedures can be lifesaving.
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Findings Support Personalized Cardiovascular Treatment Decisions
The study’s findings highlight the importance of shared decision-making between healthcare professionals and patients when selecting treatment strategies for stable heart disease. According to the research team, decisions about invasive procedures should consider symptom severity, potential clinical benefits, procedural risks and individual patient preferences. Researchers are also working to develop decision-support tools that combine factors such as age, coronary disease severity, heart and kidney function, and symptom burden with long-term survival information. These tools could help clinicians identify patients who may benefit most from invasive treatment while avoiding unnecessary procedures in others. The research was co-led by Judith S. Hochman, MD, and Rebecca Anthopolos, PhD, from NYU Grossman School of Medicine. The investigation received funding through a National Institutes of Health grant. Although the findings provide valuable evidence regarding long-term mortality, the extended analysis did not comprehensively assess nonfatal heart attacks, repeat procedures or quality-of-life outcomes beyond the original trial period. Additional research will therefore remain important for understanding the broader clinical impact of both treatment strategies. Overall, ISCHEMIA-EXTEND reinforces the role of evidence-based medical therapy and individualized care in managing stable coronary artery disease, while demonstrating that routine early invasive procedures do not necessarily provide an additional long-term survival benefit.
Source: NYU Langone Health press release
