Survival benefit of coronary revascularization after myocardial perfusion SPECT: The role of ischemia
| Autor: | Nikolay Yefremov, Vitaly Prokhorov, Andrzej Bojko, Piotr J. Slomka, Idan Hollander, Biatriz Hemo, Judith Tsamir, Marina Pinskiy, Tali Sharir, Katz Amos |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Ischemia Ischemia 030204 cardiovascular system & hematology Revascularization Disease-Free Survival 030218 nuclear medicine & medical imaging Cohort Studies 03 medical and health sciences Myocardial perfusion imaging 0302 clinical medicine Internal medicine Myocardial Revascularization medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Myocardial infarction Aged Tomography Emission-Computed Single-Photon medicine.diagnostic_test business.industry Mortality rate Hazard ratio Myocardial Perfusion Imaging Middle Aged medicine.disease Survival Rate Treatment Outcome Cardiology Female Cardiology and Cardiovascular Medicine business Perfusion Mace |
| Zdroj: | Journal of Nuclear Cardiology. 28:1676-1687 |
| ISSN: | 1532-6551 1071-3581 |
| DOI: | 10.1007/s12350-019-01932-4 |
| Popis: | Survival benefit of revascularization over medical therapy (MT) in patients with stable ischemic heart disease (SIHD) is uncertain. We evaluated the prognostic effects of revascularization in patients with SIHD undergoing single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). Of 47,894 patients, 7973 had ischemia ≥ 5% of the left ventricle. Of these, 1837 underwent early revascularization (≤ 60 days after SPECT-MPI). The rest were MT subgroup. Follow-up period was 4.04 ± 1.86 years. Statin therapy intensity and adherence were assessed. Outcomes were all-cause mortality, death + non-fatal myocardial infarction (MI), and MACE [major adverse cardiac event = death + MI + late revascularization (> 60 days after SPECT-MPI)]. Among patients with moderate-severe ischemia (≥ 10%), death rate was lower in early revascularization compared to MT subgroup (1.42%/year vs 3.12%/year, adjusted hazard ratio (HR) 0.67 (95% CI 0.50-0.90, P = .008). Death + MI and MACE rates were also lower, adjusted HR 0.69 (0.55-0.88, P = .003) and 0.80 (0.69-0.92, P = .003). Revascularization was beneficial in optimal statin therapy subgroup (death rate 1.04%/year vs 2.36%/year, adjusted HR 0.51 (0.30-0.86, P = .012). In mild ischemia (5%-9%), revascularization did not improve survival or MI-free survival, and was associated with higher MACE rate (8.86%/year vs 7.67%/year, adjusted HR 1.30 (1.12-1.52, P |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink