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The primary endpoint of the ISCHEMIA trial, whose results were presented at the American Heart Association congress back in 2019, was to determine whether an initial invasive strategy of cardiac catheterization and successful revascularization plus optimal medical treatment would reduce the primary composite endpoint of cardiovascular death or myocardial infarction in patients with chronic coronary syndrome compared to an initial conservative strategy of optimal medical treatment. Out of 5179 patients, 2588 were randomized to receive an invasive strategy and 2591 to receive conservative strategy. At the 4-year follow-up, the primary endpoint showed no significant differences between both groups revolutionizing mass media. In our opinion, we should be cautious when interpreting the results of a study that has not been published yet. There is no doubt, however, that the ISCHEMIA trial deals with an important matter, that the most powerful medical treatment was able to modify the natural history of this disease in patients with chronic coronary syndrome.

ISCHEMIA trial: what is the role of revascularization in patients with chronic coronary syndromes?