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Cardiovascular event risk estimated after coronary revascularization and optimal medical therapy: J-ACCESS4
Tomohiko Sakatani1, Kenichi Nakajima2, Hiroshi Fujita1
1Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan.
Insights
Reducing cardiac event risk through therapies like revascularization is crucial for patients with coronary artery disease. Improvements in myocardial perfusion and left ventricular ejection fraction are key to avoiding major cardiac events.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- The J-ACCESS study identified cardiac event risk factors using quantitative gated myocardial single-photon emission computed tomography (SPECT).
- Patients with moderate-to-high risk coronary artery disease (CAD) were followed after revascularization and/or optimal medical therapy (OMT).
- This study investigated the impact of changes in estimated risk on therapeutic outcomes.
Purpose of the Study:
- To determine the relevance of changes in estimated cardiac event risk to outcomes in CAD patients treated with revascularization and/or OMT.
- To assess the effectiveness of interventions in reducing cardiac event risk.
- To correlate risk reduction with clinical outcomes.
Main Methods:
- 494 patients with possible or definite CAD underwent 99mTc-tetrofosmin myocardial perfusion SPECT (MPS) before and 8 months after therapy.
- Cardiac event risk was calculated using a J-ACCESS-based equation over a 3-year follow-up.
- Analysis focused on 31 patients with ≥10% initial cardiac event risk, followed for at least 1 year.
Main Results:
- Estimated cardiac event risk decreased by ≥5% in 45% of analyzed patients.
- A significant decrease in %summed stress scores was observed post-therapy.
- Patients showing risk reduction experienced a significant increase in resting left ventricular ejection fraction (LVEF) compared to those without.
Conclusions:
- Reduction in cardiac ischemia and improvement in LVEF are essential for preventing cardiac events in moderate-to-high risk CAD patients.
- Changes in quantifiable cardiac event risk predict therapeutic outcomes.
- Myocardial perfusion SPECT is valuable for assessing treatment effectiveness and guiding patient management.
Background:
An assessment of cardiac events and survival using quantitative gated myocardial single-photon emission computed tomography (SPECT) (J-ACCESS) associated several risk factors with cardiac events in Japan. The clinical course after revascularization and/or optimal medical therapy (OMT) was followed in patients with coronary artery disease (CAD) at moderate-to-high risk estimated by software incorporating the J-ACCESS risk model. The present study aimed to determine the relevance of changes in estimated risk to outcomes of these therapies.
Methods:
This study included 494 patients with possible or definite CAD who underwent initial pharmacological stress 99mTc-tetrofosmin myocardial perfusion SPECT (MPS) before and eight months after therapy. Major cardiac event risk during 3 years of follow-up was calculated using an equation based on that in the J-ACCESS study. Patients with ≥ 10% cardiac event risk estimated at the first MPS (n = 31) were analyzed and followed up for at least 1 year.
Results:
Estimated risk was reduced by ≥ 5% in 14 patients (45%) after therapy. During a follow-up period of 22.1 ± 6.7 months, one patient without such reduction had a major cardiac event. Mean %summed stress scores significantly decreased from baseline to follow-up in patients with and without risk reduction. Left ventricular ejection fraction (LVEF [%]) at rest was significantly increased at the second, compared with the first MPS between patients with, than without risk reduction (57 ± 17 vs. 45 ± 16%, p = 0.001 and 50 ± 11 vs. 49 ± 9%, p = 0.953, respectively).
Conclusions:
A reduction in cardiac ischemia and an increase in LVEF by revascularization and/or OMT were necessary to avoid cardiac events among patients with moderate-to-high estimated risk, and changes in event risk were quantifiable.
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