No difference in long-term all-cause mortality observed with invasive versus conservative management of high-risk chronic coronary disease
FRIDAY, Nov. 13, 2026 (HealthDay News) — For patients with high-risk chronic coronary disease, long-term all-cause mortality does not differ with routine invasive versus initial conservative management, according to a study published online Nov. 7 in the Journal of the American Medical Association to coincide with the American Heart Association Scientific Sessions 2026, held from Nov. 6 to 9 in Chicago.
Judith S. Hochman, M.D., from the NYU Grossman School of Medicine in New York City, and colleagues compared the effects of initial invasive and conservative strategies on long-term mortality in patients with chronic coronary disease. A total of 5,179 participants at 320 sites in 37 countries were randomly assigned to an initial invasive strategy of guideline-directed medical therapy plus coronary angiography and revascularization when feasible or an initial conservative strategy with guideline-directed medical therapy alone with invasive management if medical therapy failed.
The researchers found that during a median follow-up of nine years, there were 1,071 deaths: 672, 359, and 40 cardiovascular, noncardiovascular, and unclassified, respectively. There was no significant difference in all-cause 11-year mortality (25.8 and 26.9 percent for invasive and conservative management, respectively). The posterior probability of more than 1 percentage-point survival benefit was low for invasive versus conservative management by Bayesian analysis (18 percent). At 11 years, cardiovascular mortality did not differ significantly and was 15.8 and 17.1 percent in the invasive and conservative groups, respectively; noncardiovascular mortality was 9.1 and 8.1 percent, respectively.
“Our analyses make clear that while managing stable coronary artery disease with early heart procedures helps relieve chest pain and improves quality of life in those with chest pain, it is unlikely to help patients live longer,” Hochman said in a statement.
Several authors disclosed ties to the biopharmaceutical and medical device industries.
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