Advances in Interventional Cardiology
eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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1/2026
vol. 22
 
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abstract:
Original paper

Guideline-directed medical therapy in Polish patients with chronic coronary syndrome and advanced chronic kidney disease: insights from the ISCHEMIA-CKD trial

Radosław Pracoń
1
,
Rebecca Anthopolos
2
,
Ying Lu
2
,
Marcin Demkow
1
,
Tomasz Mazurek
3
,
Jarosław Drożdż
4
,
Piotr Pruszczyk
5
,
Marek Roik
5
,
Karolina Kryczka
1
,
Jan Henzel
1
,
Edyta Kaczmarska-Dyrda
1
,
Robert Małecki
6, 7
,
Anna Teresińska
8
,
Hanna Szwed
8
,
Witold Rużyłło
8

  1. Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
  2. Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, USA
  3. 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
  4. Department of Cardiology, Medical University of Lodz, Poland
  5. Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
  6. Nephrology Department, Międzyleski Szpital Specjalistyczny, Warsaw, Poland
  7. First Department of Internal Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
  8. National Institute of Cardiology, Warsaw, Poland
Adv Interv Cardiol 2026; 22, 1 (83): 1–7
DOI: https://doi.org/10.5114/aic.2026.160027
Online publish date: 2026/03/09
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Introduction
The ISCHEMIA-CKD trial showed similar outcomes with an initial conservative vs invasive approach to chronic coronary syndrome in patients with advanced chronic kidney disease. Guideline-directed medical therapy (GDMT) was recommended regardless of the randomized strategy assignment.

Aim
To describe GDMT attainment in ISCHEMIA-CKD participants in Poland compared to other world regions.

Material and methods
Among 777 trial participants, 105 were randomized in Poland. Patients were followed for a median of 2.2 years with the following GDMT recommendations: not smoking, systolic blood pressure (SBP) < 140/ diastolic blood pressure (DBP) < 90 mm Hg, high/moderate-intensity statin, antiplatelet/anticoagulant, angiotensin-converting-enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARB) and b-blocker therapy, glycated hemoglobin (HbA1c) < 8% when indicated.

Results
Participants in Poland vs other regions of the world (age 67 [60, 76] vs. 63 [55, 70] years, p < 0.001, 32% vs. 31% females, p = 0.86) had higher incidence of prior myocardial infarction (25% vs. 16%, p = 0.04), peripheral vascular disease (12% vs. 5%, p = 0.009), atrial fibrillation (23% vs. 7%, p < 0.001), and less frequently diabetes (44% vs. 59%, p = 0.004). At baseline, Polish participants were more often on antiplatelets/anticoagulants (91% vs. 83%, p = 0.04), b-blockers (95% vs. 72%, p < 0.001), and ACE-I/ARBs (62% vs. 45%, p = 0.002), with better attainment of SBP < 140 (73% vs. 53%, p < 0.001), and HbA1c < 8% (86% vs. 56%, p = 0.003) and similar smoking and high-/moderate-intensity statin treatment frequencies. This degree of GDMT goal attainment was maintained at the last follow-up visit.

Conclusions
In Polish patients with advanced kidney disease, high GDMT goal attainment was observed and maintained until the last follow-up visit under trial-specific, strict medical surveillance. The impact of GDMT on long-term outcomes remains to be studied in this patient population.

keywords:

chronic coronary syndrome, advanced chronic kidney disease, coronary revascularization, optimal medical therapy

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