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Coronary Artery DiseaseApril 2020Summary reviewed June 2026

What the ISCHEMIA-CKD Trial Found — Surgery vs. Medication for Heart Disease in Kidney Patients

Researchers tested whether heart surgery or stents helped people with both advanced kidney disease and blocked heart arteries. After two years, patients who had surgery were no less likely to die or have a heart attack than those treated with medication alone. Surgery carried higher stroke risk.

What the trial was testing

The ISCHEMIA-CKD enrolled 777 patients with coronary artery disease. The study was sponsored by NYU Langone Health and tracked outcomes across the full group of patients who matched the trial's eligibility profile.

It was long-term safety (phase 4). Trials at this stage are designed to produce evidence regulators and physicians can act on — not just observations to follow up later.

What the results showed

Heart surgery showed no benefit over medication alone in patients with advanced kidney disease and blocked arteries.

The New England journal of medicine · 2020 · NCT01985360

These findings — that surgery and medication-only groups had virtually identical rates of death or heart attack — were published in the The New England journal of medicine and represent the headline result of the study.

Researchers tracked outcomes across 777 patients enrolled in the trial. The result was consistent enough across the group that the team felt confident reporting it.

What this means for patients

For patients with coronary artery disease, this result changes the calculus on what to ask their care team about. Whether it changes day-to-day care depends on factors like disease subtype, prior treatments, and where the patient is in their care journey.

What you can do now

If you have advanced kidney disease and stable heart disease, medication alone may be as effective as surgery or stents. The trial found surgery increased stroke risk without reducing heart attacks or death. Talk to your cardiologist and kidney doctor about the best treatment plan for your situation.

Eligibility for the treatments mentioned above depends on specific test results and clinical history. Bring this summary, the trial name, and your most recent labs or pathology report to your next visit.