Bangalore S, Maron DJ, O’Brien SM, et al. - In the light of the routine exclusion of patients with advanced chronic kidney disease from the clinical trials that have evaluated the impact of revascularization in patients experiencing stable coronary disease, researchers undertook this study with 777 patients having advanced kidney disease and moderate or severe ischemia on stress testing. The participants were randomized to be managed with an initial invasive strategy including coronary angiography and revascularization (if suitable) added to medical treatment or an initial conservative strategy comprising medical treatment alone and angiography reserved for those in whom medical therapy had failed. A composite of mortality or nonfatal myocardial infarction was the primary outcome. The participants were observed for a median duration of 2.2 years. Experts did not find proof that an initial invasive strategy afforded decrease in the risk of mortality or nonfatal myocardial infarction, vs an initial conservative strategy, among patients suffering from stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia.