Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD, welcome Dr. Nobuhiro Ikemura of Tachikawa Hospital, formerly of Saint Luke’s Mid America Heart Institute to discuss trajectories of angina following initial invasive versus conservative strategies for chronic coronary disease. Dr. Ikemura provides expert commentary on the recent JACC publication (Trajectories of Angina After Initial Invasive vs Conservative Strategy for Chronic Coronary Disease, ISCHEMIA Research Group), which analyzed 2,977 patients with baseline angina from the ISCHEMIA trial using latent class trajectory modeling to identify six distinct symptom patterns over two years. The study revealed that an invasive approach more often produced rapid or early improvement, while many conservatively managed patients had persistent angina, especially women and smokers. These findings highlight how capturing the “patient journey” beyond averages can inform shared decision-making, guide follow-up, and shape individualized treatment strategies in chronic coronary disease.