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Benefit of Early Revascularization Based on Inducible Ischemia and Left Ventricular Ejection Fraction.
Rozanski, Alan; Miller, Robert J H; Gransar, Heidi; Han, Donghee; Slomka, Piotr; Dey, Damini; Hayes, Sean W; Friedman, John D; Thomson, Louise; Berman, Daniel S.
Affiliation
  • Rozanski A; Department of Cardiology, Mount Sinai Morningside Hospital and Mount Sinai Heart, New York, New York, USA. Electronic address: alanrozanski@mountsinai.org.
  • Miller RJH; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
  • Gransar H; Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  • Han D; Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  • Slomka P; Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  • Dey D; Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  • Hayes SW; Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  • Friedman JD; Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  • Thomson L; Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  • Berman DS; Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
J Am Coll Cardiol ; 80(3): 202-215, 2022 07 19.
Article in En | MEDLINE | ID: mdl-35835493
ABSTRACT

BACKGROUND:

The utility of performing early myocardial revascularization among patients presenting with inducible myocardial ischemia and low left ventricular ejection fraction (LVEF) is currently unknown.

OBJECTIVES:

In this study, we sought to assess the relationship between stress-induced myocardial ischemia, revascularization, and all-cause mortality (ACM) among patients with normal vs low LVEF.

METHODS:

We evaluated 43,443 patients undergoing stress-rest single-photon emission computed tomography myocardial perfusion imaging from 1998 to 2017. Median follow-up was 11.4 years. Myocardial ischemia was assessed for its interaction between early revascularization and mortality. A propensity score was used to adjust for nonrandomization to revascularization, followed by multivariable Cox modeling adjusted for the propensity score and clinical variables to predict ACM.

RESULTS:

The frequency of myocardial ischemia varied markedly according to LVEF and angina, ranging from 6.7% among patients with LVEF ≥55% and no typical angina to 64.0% among patients with LVEF <45% and typical angina (P < 0.001). Among 39,883 patients with LVEF ≥45%, early revascularization was associated with increased mortality risk among patients without ischemia and lower mortality risk among patients with severe (≥15%) ischemia (HR 0.70; 95% CI 0.52-0.95). Among 3,560 patients with LVEF <45%, revascularization was not associated with mortality benefit among patients with no or mild ischemia, and was associated with decreased mortality among patients with moderate (10%-14%) (HR 0.67; 95% CI 0.49-0.91) and severe (≥15%) (HR 0.55; 95% CI 0.38-0.80) ischemia.

CONCLUSIONS:

Within this cohort, early myocardial revascularization was associated with a significant reduction in mortality among both patients with normal LVEF and severe inducible myocardial ischemia and patients with low LVEF and moderate or severe inducible myocardial ischemia.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Coronary Artery Disease / Myocardial Ischemia / Myocardial Perfusion Imaging Type of study: Prognostic_studies Limits: Humans Language: En Journal: J Am Coll Cardiol Year: 2022 Document type: Article
Fulltext
Add to My VHL
Print
XML
PubMed Links
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Coronary Artery Disease / Myocardial Ischemia / Myocardial Perfusion Imaging Type of study: Prognostic_studies Limits: Humans Language: En Journal: J Am Coll Cardiol Year: 2022 Document type: Article