Association of Ischemia Localization with Recorded PCI Procedural Category in Patients Undergoing Myocardial...

Background: Myocardial perfusion imaging (MPI) plays a central role in the noninvasive evaluation of myocardial ischemia and in guiding clinical management in patients with suspected or known coronary artery disease. While ischemic burden is an established component of MPI interpretation, the relationship between ischemia localization and the procedural strategy recorded among patients undergoing percutaneous coronary intervention (PCI) remains less well defined. This study aimed to evaluate whether the anatomical localization of ischemia identified by MPI was associated with the two PCI procedural categories recorded in the study dataset (Stent versus PTCA + stent). Methods: In this retrospective cohort study, 328 patient records were assessed for eligibility and 268 patients with complete MPI localization and treatment data were included. Seven patients received medical therapy alone and 261 underwent percutaneous coronary intervention (PCI); no patient underwent coronary artery bypass grafting (CABG). Within the PCI subgroup, the mutually exclusive patient-level source labels were Stent (including capitalization variants) and PTCA + STENT; no PTCA-only category was present. Because of the small medical-therapy group, inferential analyses were restricted to the 261 PCI patients. The overall association between the 13 ischemia-localization categories and PCI procedural category was assessed using the Fisher-Freeman-Halton exact test with Monte Carlo estimation. Multivariable logistic regression was performed with Stent as the dependent category and age, sex, anterior involvement, and multiregional ischemia as explanatory variables. Results: Among the 261 patients undergoing PCI, 144 were recorded in the Stent category and 117 in the PTCA + stent category. Across all 13 ischemia-localization categories, no statistically significant overall association was observed between ischemia localization and PCI procedural category (Fisher-Freeman-Halton exact test with Monte Carlo estimation, p = 0.7843). In multivariable analysis, anterior involvement (adjusted OR 1.02, 95% CI 0.58-1.82; p = 0.935) and multiregional ischemia (adjusted OR 0.69, 95% CI 0.33-1.41; p = 0.304) were not significantly associated with procedural category. Age was also not significantly associated with procedural category (adjusted OR 1.00, 95% CI 0.97-1.03; p = 0.993). Male sex was associated with lower adjusted odds of being in the Stent category relative to PTCA + stent (adjusted OR 0.40, 95% CI 0.23-0.70; p = 0.0012). Conclusions: In this cohort of patients undergoing PCI, ischemia localization was not significantly associated with the recorded procedural category (Stent versus PTCA + stent). The observed association with sex was secondary and should be interpreted cautiously. Given the very small medical-therapy group, no reliable conclusions can be drawn from this cohort regarding the likelihood of PCI versus medical management or comparative treatment efficacy.