Impact of coronary revascularization vs medical therapy on ischemia among stable patients with or suspected coronary artery disease undergoing serial myocardial perfusion scintigraphy

Francesco Nudi, Natale Di Belardino, Francesco Versaci, Annamaria Pinto, Enrica Procaccini, Giandomenico Neri, Maurizio Vetere, Giacomo Frati, Mariangela Peruzzi, Orazio Schillaci, Achille Gaspardone, Fabrizio Tomai, Giuseppe Biondi-Zoccai

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Randomized trials have challenged the role of revascularization in stable coronary artery disease. We aimed to appraise the impact of revascularization on ischemia in patients undergoing serial myocardial perfusion scintigraphy (MPS). Methods: We queried our institutional database for stable subjects undergoing serial MPS and appraised the impact of revascularization on changes in ischemia. Results: A total of 3631 patients were included: 967 (27%) undergoing revascularization and 2664 (73%) receiving medical therapy only. Patients treated with revascularization had a significantly lower burden of myocardial ischemia at follow-up (odds ratio = 0.577 [95% confidence interval 0.483-0.689] vs medical therapy, P <.001). Among all those having moderate or severe ischemia at baseline, revascularization was associated with a follow-up prevalence of 80% for no, minimal, or mild ischemia and 20% for moderate or severe ischemia, vs 43% and 57% for medical therapy (P <.001). Even at multivariable analysis and propensity-adjusted, and propensity-matched analyses, revascularization was associated with a significantly lower prevalence of moderate or severe ischemia at follow-up (respectively P <.001, P = .001, and P = .042). Conclusions: Revascularization appears superior to medical therapy in reducing ischemic burden and normalizing myocardial perfusion among subjects with moderate or severe ischemia at baseline.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalJournal of Nuclear Cardiology
DOIs
Publication statusPublished - Oct 2017

Keywords

  • Cardiovascular disease
  • coronary artery bypass grafting
  • coronary artery disease
  • maximal ischemia score
  • myocardial ischemia
  • myocardial perfusion imaging
  • myocardial perfusion scintigraphy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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