TY - JOUR
T1 - Impact of coronary revascularization vs medical therapy on ischemia among stable patients with or suspected coronary artery disease undergoing serial myocardial perfusion scintigraphy
AU - Nudi, Francesco
AU - Di Belardino, Natale
AU - Versaci, Francesco
AU - Pinto, Annamaria
AU - Procaccini, Enrica
AU - Neri, Giandomenico
AU - Vetere, Maurizio
AU - Frati, Giacomo
AU - Peruzzi, Mariangela
AU - Schillaci, Orazio
AU - Gaspardone, Achille
AU - Tomai, Fabrizio
AU - Biondi-Zoccai, Giuseppe
PY - 2017/10
Y1 - 2017/10
N2 - 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.
AB - 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.
KW - Cardiovascular disease
KW - coronary artery bypass grafting
KW - coronary artery disease
KW - maximal ischemia score
KW - myocardial ischemia
KW - myocardial perfusion imaging
KW - myocardial perfusion scintigraphy
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U2 - 10.1007/s12350-016-0504-5
DO - 10.1007/s12350-016-0504-5
M3 - Article
AN - SCOPUS:84970002707
SP - 1
EP - 9
JO - Journal of Nuclear Cardiology
JF - Journal of Nuclear Cardiology
SN - 1071-3581
ER -