Impact of Early Revascularization on Major Adverse Cardiovascular Events in Relation to Automatically
Peyman N Azadani1, Robert J H Miller2, Tali Sharir3
1Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
Insights
Early revascularization in patients with significant ischemia (>10.2%) on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) reduces major adverse cardiovascular events (MACE). This multicenter study confirms benefits in contemporary practice.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Interventional Cardiology
Background:
- Previous single-center studies suggested a link between moderate-to-severe ischemia on SPECT-MPI and improved outcomes with early revascularization.
- This study aimed to validate these findings in a larger, international cohort.
Purpose of the Study:
- To assess the association between early revascularization and major adverse cardiovascular events (MACE) in patients undergoing SPECT-MPI.
- To characterize the benefit of early revascularization based on automatically quantified ischemia.
Main Methods:
- A multicenter international registry of 19,088 patients who underwent SPECT-MPI between 2009-2014 was analyzed.
- Ischemia was automatically quantified as ischemic total perfusion deficit (TPD). Early revascularization was defined as within 90 days.
- Propensity score and multivariable Cox modeling were used to adjust for nonrandomization and predict MACE.
Main Results:
- Over a mean follow-up of 4.7 years, 9.6% of patients experienced MACE.
- A significant interaction was observed between ischemic TPD and early revascularization (p=0.012).
- Early revascularization was associated with reduced MACE in patients with >10.2% ischemic TPD.
Conclusions:
- Early revascularization in patients with >10.2% ischemia on SPECT-MPI is associated with reduced MACE.
- This finding is based on a large, international, multicenter study reflecting contemporary cardiology practice.
- Automatic quantification of ischemia aids in identifying patients who benefit from early revascularization.
Objectives:
Using a contemporary, multicenter international single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) registry, this study characterized the potential major adverse cardiovascular event(s) (MACE) benefit of early revascularization based on automatic quantification of ischemia.
Background:
Prior single-center data reported an association between moderate to severe ischemia SPECT-MPI and reduced cardiac death with early revascularization.
Methods:
Consecutive patients from a multicenter, international registry who underwent 99mTc SPECT-MPI between 2009 and 2014 with solid-state scanners were included. Ischemia was quantified automatically as ischemic total perfusion deficit (TPD). Early revascularization was defined as within 90 days. The primary outcome was MACE (death, myocardial infarction, and unstable angina). A propensity score was developed to adjust for nonrandomization of revascularization; then, multivariable Cox modeling adjusted for propensity score and demographics was used to predict MACE.
Results:
In total, 19,088 patients were included, with a mean follow-up of 4.7 ± 1.6 years, during which MACE occurred in 1,836 (9.6%) patients. There was a significant interaction between ischemic TPD modeled as a continuous variable and early revascularization (interaction p value: 0.012). In this model, there was a trend toward reduced MACE in patients with >5.4% ischemic TPD and a significant association with reduced MACE in patients with >10.2% ischemic TPD.
Conclusions:
In this large, international, multicenter study reflecting contemporary cardiology practice, early revascularization of patients with >10.2% ischemia on SPECT-MPI, quantified automatically, was associated with reduced MACE.
