Extent of Myocardial Ischemia on Positron Emission Tomography and Survival Benefit With Early Revascularization
| Autor: | Kevin F. Kennedy, Brett W. Sperry, James A. Case, Krishna Patel, Paul Chan, John A. Spertus, Firas Al Badarin, Staci Courter, Randall C. Thompson, Timothy M. Bateman, Ibrahim M. Saeed, A. Iain McGhie |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Ischemia Ischemia Cardiomyopathy 030204 cardiovascular system & hematology Revascularization Article Cohort Studies 03 medical and health sciences Myocardial perfusion imaging 0302 clinical medicine Positron Emission Tomography Computed Tomography Internal medicine Myocardial Revascularization medicine Humans 030212 general & internal medicine Aged medicine.diagnostic_test business.industry Proportional hazards model Middle Aged medicine.disease Survival Rate Positron emission tomography Cardiology Female Cardiology and Cardiovascular Medicine business Perfusion Emission computed tomography Follow-Up Studies |
| Zdroj: | J Am Coll Cardiol |
| ISSN: | 0735-1097 |
| Popis: | Prior studies with single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) have shown a survival benefit with early revascularization in patients with10% to 12.5% ischemic myocardium. The relationship among positron emission tomography (PET)-derived extent of ischemia, early revascularization, and survival is unknown.The purpose of this study was to evaluate the association among percent ischemia on PET MPI, revascularization, and survival.A total of 16,029 unique consecutive patients who were undergoing Rubidium-82 rest-stress PET MPI from 2010 to 2016 were included. Patients with known cardiomyopathy and nondiagnostic perfusion results were excluded. Percent ischemic myocardium was estimated from a 17-segment model. Propensity scoring was used to account for nonrandomized referral to early revascularization (90 days of PET). A Cox model was developed, adjusting for propensity scores for early revascularization and percent ischemia, and an interaction between ischemia and early revascularization was tested.Median follow-up was 3.7 years. Overall, 1,277 (8%) patients underwent early revascularization and 2,493 (15.6%) died (738 cardiac). Nearly 37% of patients (n = 5,902) had ischemia, with 13.5% (n = 2,160) having ≥10%. In propensity-adjusted analyses, there was a significant interaction between ischemia and early revascularization (p 0.001 for all-cause and cardiac death), such that patients with greater ischemia had improved survival with early revascularization, with a potential ischemia threshold at 5% (upper limit 95% confidence interval at 10%). There was no differential association between ischemia and early revascularization on death based on history of known coronary artery disease (interaction p = 0.72).In a contemporary cohort of patients undergoing PET MPI, patients with greater ischemia had a survival benefit from early revascularization. On exploratory analyses, this threshold was lower than that previously reported for SPECT. These findings require future validation in prospective cohorts or trials. |
| Databáze: | OpenAIRE |
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