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  1. Home
  3. Impact Of Ischaemia And Scar On The Therapeutic Benefit Derived From Myocardial Revascularization Vs. Medical Therapy Among Patients Undergoing Stress-rest Myocardial Perfusion Scintigraphy.
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Impact Of Ischaemia And Scar On The Therapeutic Benefit Derived From Myocardial Revascularization Vs. Medical Therapy Among Patients Undergoing Stress-rest Myocardial Perfusion Scintigraphy.

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Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy

Rory Hachamovitch1, Alan Rozanski, Leslee J Shaw

  • 1Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.

European Heart Journal
|January 25, 2011

View abstract on PubMed

Summary
This summary is machine-generated.

Early revascularization improves survival in patients with significant ischemia and minimal scar. However, patients with prior myocardial infarction or minimal ischemia may not benefit from early revascularization.

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Area of Science:

  • Cardiology
  • Nuclear Cardiology
  • Cardiovascular Imaging

Background:

  • Pre-revascularization ischemia testing is recommended for patients with coronary artery disease (CAD).
  • The interplay between ischemia extent, myocardial scar, and revascularization outcomes on patient survival remains unclear.

Purpose of the Study:

  • To investigate the relationship between the extent of myocardial ischemia, myocardial scar burden, and the survival benefit of early revascularization in patients with known CAD.
  • To determine if prior myocardial infarction (MI) influences the survival benefit of revascularization.

Main Methods:

  • A large observational study included 13,555 patients who underwent stress myocardial perfusion scintigraphy (MPS).
  • Ischemia (%I) and scar (%F) were quantified using SPECT MPS.
  • Cox proportional hazards modeling, adjusted for propensity scores and baseline characteristics, was used to assess all-cause death (ACD).

Main Results:

  • A significant three-way interaction was found between %I, early revascularization, and history of CAD (HxCAD).
  • %I identified a survival benefit with early revascularization in patients without prior MI, but not in those with prior MI.
  • Excluding patients with >10% scar, %I identified a survival benefit in all patients, suggesting scar burden modifies the benefit of revascularization.

Conclusions:

  • Patients with significant ischemia and limited myocardial scar benefit from early revascularization.
  • Medical therapy without early revascularization may be superior for patients with minimal ischemia or extensive scar.