Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy

被引：376

作者：

Hachamovitch, Rory ^{[2
]}

Rozanski, Alan ^{[3
]}

Shaw, Leslee J. ^{[4
]}

Stone, Gregg W. ^{[5
,6
]}

Thomson, Louise E. J. ^{[1
,7
,8
]}

Friedman, John D. ^{[1
,7
,8
]}

Hayes, Sean W. ^{[1
,7
,8
]}

Cohen, Ishac ^{[1
,7
,8
]}

Germano, Guido ^{[1
,7
,8
]}

Berman, Daniel S. ^{[1
,7
,8
]}

机构：

[1] Cedars Sinai Med Ctr, Dept Imaging, Div Nucl Med, Los Angeles, CA 90048 USA

[2] Cleveland Clin, Dept Cardiovasc Med, Sect Cardiovasc Imaging, Cleveland, OH 44106 USA

[3] St Lukes Roosevelt Hosp, Dept Med, New York, NY 10025 USA

[4] Emory Univ, Sch Med, Emory Program CV Outcomes Res & Epidemiol, Atlanta, GA USA

[5] Columbia Univ, Med Ctr, New York, NY USA

[6] Cardiovasc Res Fdn, New York, NY USA

[7] Cedars Sinai Med Ctr, Dept Med, Div Cardiol, Los Angeles, CA 90048 USA

[8] Cedars Sinai Med Ctr, Cedars Sinai Heart Inst, Los Angeles, CA 90048 USA

来源：

EUROPEAN HEART JOURNAL | 2011年 / 32卷 / 08期

关键词：

Myocardial perfusion SPECT; Prognosis; Revascularization; Medical therapy; CORONARY-ARTERY-DISEASE; CHRONIC STABLE ANGINA; PROPENSITY SCORE; VALIDATION; INTERVENTION; MANAGEMENT;

D O I：

10.1093/eurheartj/ehq500

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims Although pre-revascularization ischaemia testing is recommended, the interaction between the extent of ischaemia and myocardial scar with performance of revascularization on patient survival is unclear. Methods and results We identified 13 969 patients who underwent adenosine or exercise stress SPECT myocardial perfusion scintigraphy (MPS). The percent myocardium ischaemic (%I) and fixed (%F) were calculated using 5 point/20-segment MPS scoring. Patients lost to follow-up (2.8%) were excluded leaving 13 555 patients [ 35% with history (Hx) of known coronary artery disease (CAD), 65% exercise stress, 61% male, age 66 +/- 12]. Follow-up was performed at 12-18 months for early revascularization and at >7 years for all-cause death (ACD) (mean follow-up 8.7 +/- 3.3 years). All-cause death was modelled using Cox proportional hazards modelling adjusting for logistic-based propensity scores, MPS, revascularization, and baseline characteristics. During FU, 3893 ACD (29%, 3.3%/year) and 1226 early revascularizations (9.0%) occurred. After risk-adjustment, a three-way interaction was present between %I, early revascularization, and HxCAD, such that %I identified a survival benefit with early revascularization in patients without prior myocardial infarction (MI), whereas no such benefit was present in patients with prior MI (overall model x(2) = 3932, P < 0.001; interaction P < 0.021). Further modelling revealed that after excluding patients with scar > 10% total myocardium, %I identified a survival benefit in all patients. Conclusion In this large observational series with long-term follow-up, patients with significant ischaemia and without extensive scar were likely to realize a survival benefit from early revascularization. In contrast, the survival of patients with minimal ischaemia was superior with medical therapy without early revascularization.

引用

页码：1012 / 1024

页数：13

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