Survival benefit of coronary revascularization after myocardial perfusion SPECT: The role of ischemia

Tali Sharir, Idan Hollander, Biatriz Hemo, Judith Tsamir, Nikolay Yefremov, Andrzej Bojko, Vitaly Prokhorov, Marina Pinskiy, Piotr Slomka, Katz Amos

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background: Survival benefit of revascularization over medical therapy (MT) in patients with stable ischemic heart disease (SIHD) is uncertain. We evaluated the prognostic effects of revascularization in patients with SIHD undergoing single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). Methods: Of 47,894 patients, 7973 had ischemia ≥ 5% of the left ventricle. Of these, 1837 underwent early revascularization (≤ 60 days after SPECT-MPI). The rest were MT subgroup. Follow-up period was 4.04 ± 1.86 years. Statin therapy intensity and adherence were assessed. Outcomes were all-cause mortality, death + non-fatal myocardial infarction (MI), and MACE [major adverse cardiac event = death + MI + late revascularization (> 60 days after SPECT-MPI)]. Results: Among patients with moderate-severe ischemia (≥ 10%), death rate was lower in early revascularization compared to MT subgroup (1.42%/year vs 3.12%/year, adjusted hazard ratio (HR) 0.67 (95% CI 0.50-0.90, P =.008). Death + MI and MACE rates were also lower, adjusted HR 0.69 (0.55-0.88, P =.003) and 0.80 (0.69-0.92, P =.003). Revascularization was beneficial in optimal statin therapy subgroup (death rate 1.04%/year vs 2.36%/year, adjusted HR 0.51 (0.30-0.86, P =.012). In mild ischemia (5%-9%), revascularization did not improve survival or MI-free survival, and was associated with higher MACE rate (8.86%/year vs 7.67%/year, adjusted HR 1.30 (1.12-1.52, P <.001). Conclusion: Compared to MT, revascularization was associated with reduced risk of death, death + MI, and MACE in patients with moderate-severe ischemia, incremental over optimal statin therapy. In mild ischemia, revascularization was associated with higher risk of MACE, driven by late revascularization, with no impact on death and death + MI.

Original languageEnglish
Pages (from-to)1676-1687
Number of pages12
JournalJournal of Nuclear Cardiology
Volume28
Issue number4
DOIs
StatePublished - 1 Aug 2021
Externally publishedYes

Keywords

  • CAD
  • Diagnostic and prognostic application
  • MPI
  • SPECT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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