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Ischemia burden on stress SPECT MPI predicts long-term outcomes after revascularization in stable coronary artery
Hendrik J Boiten1, Jan C van den Berge2, Roelf Valkema3
1Department of Cardiology, Erasmus Medical Center, Thoraxcenter Room Ba304, 3015 CE, Rotterdam, The Netherlands. henkjan_boiten@hotmail.com.
Insights
Early revascularization in patients with myocardial ischemia identified on stress single-photon emission computed tomography (SPECT) significantly reduces long-term all-cause and cardiac mortality, especially in those with moderate to high ischemia burden.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Interventional Cardiology
Background:
- The prognostic value of ischemia burden on stress single-photon emission computed tomography (SPECT) for long-term benefit after coronary revascularization remains unclear.
- Stress SPECT is a key diagnostic tool for assessing myocardial ischemia.
Purpose of the Study:
- To determine if ischemia burden on stress SPECT identifies patients who benefit long-term from coronary revascularization.
- To evaluate the impact of early revascularization on long-term mortality in patients with myocardial ischemia.
Main Methods:
- A cohort of 719 patients with ischemia on stress SPECT was analyzed.
- Early revascularization was defined as procedures within 90 days of SPECT.
- Patients were stratified by ischemia burden (low vs. moderate to high) and followed for a median of 12 years.
Main Results:
- Of 538 analyzed patients, 348 had low ischemia burden and 190 had moderate to high burden.
- Early revascularization (n=76) was associated with reduced all-cause mortality (HR 0.46) and cardiac mortality (HR 0.54).
- The survival benefit of early revascularization was most pronounced in patients with moderate to high ischemia burden.
Conclusions:
- Early coronary revascularization in patients with stress SPECT-detected myocardial ischemia improves long-term survival compared to medical therapy alone.
- The degree of ischemia burden on stress SPECT influences the long-term benefit of early revascularization.
- Stress SPECT findings, particularly moderate to high ischemia burden, can guide revascularization decisions for improved patient outcomes.
Background:
It is not entirely clear whether ischemia burden on stress single-photon emission computed tomography (SPECT) effectively identifies patients who have a long-term benefit from coronary revascularization.
Methods:
The study population consisted of 719 patients with ischemia on stress SPECT. Early coronary revascularization was defined as percutaneous coronary intervention or coronary artery bypass grafting ≤90 days after SPECT. Patients who underwent late revascularization (>90 days after SPECT) were excluded (n = 164).
Results:
Of the 538 patients (73% men, mean age 59.8 ± 11 years), 348 patients had low ischemia burden (<3 ischemic segments) and 190 patients had moderate to high ischemia burden (≥3 ischemic segments). A total of 76 patients underwent early revascularization. During a median follow-up of 12 years (range 4-17), 283 patients died of whom 125 due to cardiac causes. Early revascularization was beneficial on all-cause mortality (HR 0.46, 95% CI 0.30-0.46) and cardiac mortality (HR 0.54, 95% CI 0.29-0.99).
Conclusions:
Patients with myocardial ischemia on stress SPECT who underwent early revascularization had a lower all-cause mortality and cardiac mortality during long-term follow-up as compared to patients who received pharmacological therapy alone. This difference in long-term outcomes was mainly influenced by the survival benefit of early revascularization in the patients with moderate to high ischemia burden.
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