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Long-Term Survival Benefit of Coronary Revascularization in Patients Undergoing Stress Myocardial Perfusion Imaging
Mario Petretta1, Wanda Acampa, Stefania Daniele
1Department of Translational Medical Sciences, University of Naples Federico II.
Insights
Coronary revascularization improves outcomes in patients with coronary artery disease (CAD). The benefit is greater with severe ischemia and preserved left ventricular ejection fraction (LVEF), as shown by myocardial perfusion imaging (MPI).
Area of Science:
- Cardiology
- Nuclear Cardiology
- Medical Imaging
Background:
- Assessing clinical outcomes and coronary revascularization in patients with suspected or known coronary artery disease (CAD).
- Utilizing stress-gated myocardial perfusion single-photon emission computed tomography (MPS) for long-term follow-up.
- Observational study design in a large patient cohort.
Purpose of the Study:
- To evaluate the relationship between clinical outcome and coronary revascularization.
- To determine the predictive value of myocardial perfusion imaging (MPI) parameters on revascularization effectiveness.
- To investigate interactions between revascularization, ischemia severity (SDS), and left ventricular ejection fraction (LVEF).
Main Methods:
- Analysis of 2,059 patients with suspected or known CAD.
- Median follow-up of 61 months with 184 cardiac events (126 deaths, 58 MIs).
- Extended Cox regression model adjusting for confounders, with revascularization as a time-dependent covariate.
Main Results:
- Revascularization significantly improved event-free survival (adjusted HR, 0.19; P<0.001).
- Significant interactions found between revascularization and summed difference score (SDS; P=0.045).
- Significant interaction between LVEF and SDS (P=0.015), indicating revascularization benefit increases with higher SDS, particularly with preserved LVEF.
Conclusions:
- Both ischemia severity (SDS) and LVEF predict revascularization outcomes in CAD patients.
- The protective effect of revascularization is more pronounced in patients with severe ischemia and preserved LVEF.
- MPI parameters are crucial for guiding revascularization decisions in CAD.
Background:
We assessed the relationship between clinical outcome and coronary revascularization according to stress-gated myocardial perfusion single-photon emission computed tomography (MPS) in an observational series of patients with suspected or known coronary artery disease (CAD), on long-term follow-up.
Methods And Results:
The study group consisted of 2,059 patients. During a median follow-up of 61 months, 184 events occurred (126 cardiac deaths and 58 non-fatal MI). The impact of revascularization during follow-up on event-free survival was evaluated using an extended Cox regression model, adjusting for potential clinical and MPS confounders. Revascularization was treated as a binary non-reversible time-dependent covariate. Predefined interactions tested were: (1) revascularization and summed difference score (SDS); (2) revascularization and post-stress left ventricular (LV) ejection fraction (EF); and (3) SDS and post-stress LVEF. Revascularization had a significant effect on event-free survival (adjusted HR, 0.19; P<0.001). Significant interactions were found between revascularization and SDS (P=0.045), and between LVEF and SDS (P=0.015). The protective effect of revascularization increased as SDS increased. For SDS <6 the reduction in HR was detectable only for reduced LVEF.
Conclusions:
Both the degree of stress-induced ischemia and LVEF predict the effect of revascularization on outcome in patients with suspected or known CAD. The protective effect of revascularization appears to be greater in patients with severe ischemia and preserved LVEF.
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