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Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging
David E Winchester1,2, Alexander J Bolanos3, Anita Wokhlu1,2
1Malcom Randall VAMC, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Box 111-D, Gainesville, FL USA.
Background:
The prevalence of ischemia on nuclear myocardial perfusion imaging (MPI) has been decreasing. Recent research has questioned the benefit of invasive revascularization for patients with moderate to severe ischemia. We hypothesized that patients with moderate to severe ischemia could routinely undergo successful revascularization.
Methods:
We analyzed data from 544 patients who underwent an MPI at a single academic Veterans Affairs Medical Center. Patients with moderate to severe ischemia, defined as a summed difference score (SDS) 8 or greater, were compared to the rest of the cohort.
Results:
Of the total cohort (n = 544), 39 patients had MPI studies with resultant moderate to severe ischemia. Patients with ischemia were more likely to develop coronary artery disease (74.4% versus 38.8%, P < 0.0001) and have successful revascularization (38.5% versus 4.0%, P < 0.0001) during the following year. Revascularization was attempted in 31 patients with moderate to severe ischemia, though only 15 (47%) of these attempts were successful. Ischemia was predictive of myocardial infarction (5.1% versus 0.8%, P = 0.01) within 1 year.
Conclusion:
Moderate to severe ischemia is an uncommon finding in a contemporary nuclear laboratory. Among patients with ischemia, revascularization is typically attempted but is frequently unsuccessful.
Trial Registration:
This trial does not appear on a registry as it is neither randomized nor prospective.
Insights
Moderate to severe ischemia is uncommon and revascularization attempts are often unsuccessful. This study found that while revascularization was attempted in many patients with ischemia, success rates were low, highlighting a need for improved strategies.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Prevalence of ischemia on nuclear myocardial perfusion imaging (MPI) is declining.
- Recent research questions the benefit of invasive revascularization for patients with moderate to severe ischemia.
- This study investigates the feasibility of routine successful revascularization for such patients.
Purpose of the Study:
- To test the hypothesis that patients with moderate to severe ischemia can routinely undergo successful revascularization.
- To analyze outcomes of revascularization in patients with moderate to severe ischemia detected by MPI.
Main Methods:
- Retrospective analysis of 544 patients undergoing MPI at a Veterans Affairs Medical Center.
- Comparison of patients with moderate to severe ischemia (Summed Difference Score ≥ 8) to the general cohort.
- Evaluation of coronary artery disease, revascularization success rates, and myocardial infarction within one year.
Main Results:
- 39 patients (7.2%) had moderate to severe ischemia.
- Ischemia patients were more likely to have coronary artery disease (74.4% vs 38.8%) and undergo revascularization (38.5% vs 4.0%).
- Revascularization was attempted in 31 patients, with only 15 (47%) successful; ischemia predicted myocardial infarction (5.1% vs 0.8%).
Conclusions:
- Moderate to severe ischemia is an infrequent finding in current nuclear imaging.
- Revascularization is often attempted in patients with ischemia but success rates are frequently low.
- Further research is needed to improve revascularization outcomes in this patient group.