Conservative treatment of stable coronary disease with medications and lifestyle advice is as effective as angiography and revascularisation for patients with and without advanced kidney disease, two landmark studies show.

But for patients with frequent angina who do not have chronic kidney disease (CKD), opting for an invasive strategy may reduce their symptoms, secondary outcomes show.

The results of the ISCHEMIA and ISCHEMIA-CKD trials, first reported at the American Heart Association meeting in November 2019, have been published in four papers in the New England Journal of Medicine.

In the main trial (ISCHEMIA), 5179 people with stable coronary disease and moderate-to-severe ischaemia (mean age 64, 77% male) were randomised to either a treat-to-target approach, using guideline medications and angiography only if treatment failed, or the same approach plus angiography within 30 days and revascularisation if feasible.