ABC | Volume 114, Nº2, February 2020

Update Update of the Brazilian Guideline on Nuclear Cardiology – 2020 Arq Bras Cardiol. 2020; 114(2):325-429 Figure 30 – Case 5 - Angio-CT revealing severe calcification in coronary arteries. consensus, or evidence regarding benefits based solely on CS results. On the other hand, recommendations exist for individuals with high-risk anatomy, at least moderate ischemic burden (in terms of extent and intensity), and the presence of symptoms refractory to clinical treatment. 14 Notwithstanding indications documented in guidelines, levels of evidence demonstrating the benefits of myocardial revascularization with the aim of reducing mortality in patients with stable CAD, based both on information about anatomy 243,244 and ischemia quantification (retrospective data), 245 have been questioned, considering the absence of randomized studies published to date. With this in mind, what is known as the ISCHEMIA study 246 was designed (report to the addendum of thi guideline), randomizing patients who have at least moderate ischemia (more than 10% of the myocardium affected by ischemia of significant intensity or severity) from 400 centers worldwide into 2 treatment scenarios: “optimized clinical treatment” versus “optimized clinical treatment associated with revascularization of ischemic territory,” excluding patients with left main trunk lesion > 50% on angio-CT. The study objective was to attempt to identify subgroups where revascularization benefits stable patients, filling in this important gap in current scientific evidence. Considering the available information (current evidence and guidelines), it seems appropriate to investigate ischemia in patients with CS over 400 in the attempt to identify individuals with high ischemic burdens (extent and intensity of perfusion defects), who may benefit from invasive strategies. 372