Invasive or Conservative Strategy for Stable Coronary Disease

To the Editor: Proportional-hazards violations that are observed in trials comparing different treatment strategies lead to complex statistical interpretations.(1) However, clinical interpretation is of paramount importance. Maron et al. (April 9 issue)(2) report that in the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA), the invasive strategy was associated with a higher early risk of the primary outcome (a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) than the conservative strategy. This risk rapidly decayed over time (Fig. S7A in the Supplementary Appendix, available with . . .