Outcome of medical versus invasive treatment strategies for non-high-risk ischemic heart disease*
| Autor: | James Cullom, James H. O'Keefe, Carrie S. Barnhart, John A. Spertus, Timothy M. Bateman, James A. Case, Robert W. Ligon |
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| Rok vydání: | 1998 |
| Předmět: |
Male
Coronary angiography medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Myocardial Ischemia Ischemia Infarction Disease Revascularization Actuarial Analysis Risk Factors Internal medicine Outcome Assessment Health Care Myocardial perfusion scintigraphy Humans Medicine Radiology Nuclear Medicine and imaging Angioplasty Balloon Coronary Coronary Artery Bypass Proportional Hazards Models Retrospective Studies Tomography Emission-Computed Single-Photon business.industry Heart Middle Aged medicine.disease Surgery Exercise Test Cardiology Treatment strategy Female Cardiology and Cardiovascular Medicine business Ischemic heart Follow-Up Studies |
| Zdroj: | Journal of Nuclear Cardiology. 5:28-33 |
| ISSN: | 1071-3581 |
| Popis: | The purpose of this study was to evaluate the outcomes of medical management compared with invasive management for patients with mild or moderate ischemia (non-high-risk) on stress tomographic myocardial perfusion scintigraphy. Of the 1,352 non-high-risk patients, 116 (9%) subsequently were referred for coronary angiography within the first 30 days after the scan; 99 (85%) of this group also underwent early revascularization procedures. The remaining 1,236 patients (91%) with non-high-risk ischemia did not undergo early invasive management. Unadjusted actuarial 3-year rate of cardiac death or nonfatal infarction was significantly better estimated survival in the medically managed group (2%) compared with the invasively managed group (22%), p = 0.0001. Subsequent coronary revascularization procedures during 3-year follow-up were less frequent in the medically managed group (4%) than in the invasively managed group (42%), p = 0.0001. A multivariable analysis identified invasive management strategy (p = 0.0001) as the only correlate of cardiac events during follow-up. In summary, this study showed that patients with non-high-risk ischemia on stress perfusion imaging can be treated safely with a conservative medical management strategy. |
| Databáze: | OpenAIRE |
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