Aims The impact of coronary revascularization on outcomes and ischemic burden among patients with objective proof of ischemia is not yet established. We appraised the impact of revascularization on outcomes and residual ischemia in patients with objective evidence of ischemia at myocardial perfusion scintigraphy (MPS).Methods We queried our database for stable patients with myocardial ischemia at MPS, excluding those with prior myocardial infarction, systolic dysfunction, or cardiomyopathy. The impact of revascularization (defined as revascularization as first follow-up event) on outcomes and changes in myocardial ischemia at repeat MPS was appraised with propensity-matched analyses.Results From 6195 patients, propensity matching yielded 1262 pairs of patients undergoing revascularization versus not undergoing revascularization. After 35.2 +/- 23.9 months, revascularization was associated with lower risks of cardiac death [2 (0.2%) versus 10 (0.8%) in those not revascularized, P = 0.038] and of the composite of cardiac death or myocardial infarction [17 (1.3%) versus 37 (2.9%), P = 0.007]. In addition, revascularization was associated with a higher rate of improvement in ischemia degree after 28.1 +/- 20.7 months of follow-up (P<0.001), with 257 (69.3%) patients with moderate or severe ischemia at baseline MPS improving after revascularization versus 136 (42.0%) in the nonrevascularization group. Conversely, revascularization did not prove impactful on follow-up MPS in patients with only minimal or mild ischemia at baseline MPS (P<0.001).Conclusion In a large series of patients with objective evidence of myocardial ischemia at MPS, especially when moderate or severe, revascularization was associated with a better clinical prognosis and a lower ischemic burden at repeat MPS.

Nudi, F., Procaccini, E., Versaci, F., Giordano, A., Pinto, A., Neri, G., et al. (2017). Impact of coronary revascularization on the clinical and scintigraphic outlook of patients with myocardial ischemia. JOURNAL OF CARDIOVASCULAR MEDICINE, 18(6), 404-409 [10.2459/JCM.0000000000000506].

Impact of coronary revascularization on the clinical and scintigraphic outlook of patients with myocardial ischemia

Nudi F.;Versaci F.;Schillaci O.;Tomai F.;
2017-01-01

Abstract

Aims The impact of coronary revascularization on outcomes and ischemic burden among patients with objective proof of ischemia is not yet established. We appraised the impact of revascularization on outcomes and residual ischemia in patients with objective evidence of ischemia at myocardial perfusion scintigraphy (MPS).Methods We queried our database for stable patients with myocardial ischemia at MPS, excluding those with prior myocardial infarction, systolic dysfunction, or cardiomyopathy. The impact of revascularization (defined as revascularization as first follow-up event) on outcomes and changes in myocardial ischemia at repeat MPS was appraised with propensity-matched analyses.Results From 6195 patients, propensity matching yielded 1262 pairs of patients undergoing revascularization versus not undergoing revascularization. After 35.2 +/- 23.9 months, revascularization was associated with lower risks of cardiac death [2 (0.2%) versus 10 (0.8%) in those not revascularized, P = 0.038] and of the composite of cardiac death or myocardial infarction [17 (1.3%) versus 37 (2.9%), P = 0.007]. In addition, revascularization was associated with a higher rate of improvement in ischemia degree after 28.1 +/- 20.7 months of follow-up (P<0.001), with 257 (69.3%) patients with moderate or severe ischemia at baseline MPS improving after revascularization versus 136 (42.0%) in the nonrevascularization group. Conversely, revascularization did not prove impactful on follow-up MPS in patients with only minimal or mild ischemia at baseline MPS (P<0.001).Conclusion In a large series of patients with objective evidence of myocardial ischemia at MPS, especially when moderate or severe, revascularization was associated with a better clinical prognosis and a lower ischemic burden at repeat MPS.
2017
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA
Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE
English
Con Impact Factor ISI
coronary artery bypass grafting; coronary artery disease; maximal ischemia score; myocardial ischemia; myocardial perfusion imaging; myocardial perfusion scintigraphy; Aged; Exercise Test; Female; Humans; Italy; Linear Models; Logistic Models; Male; Middle Aged; Myocardial Ischemia; Retrospective Studies; Time Factors; Myocardial Perfusion Imaging; Myocardial Revascularization
http://ovidsp.tx.ovid.com/sp-3.33.0b/ovidweb.cgi?QS2=434f4e1a73d37e8c7467ff3d9d9f1c2f81e1508e0e2b9657af1533eb671aeb11ecca5d3ab3cc36a374ee6e0a24ab2e6205803cfd9dcd42bea2ac845fec82667ef8abc906cee2b7b06804a2ca703cb2306110987274706890534f8a9b1ea0838234cf6b91ffd2dacd417403ef6ee4fce8cdf2b411fd90aca715b8eddd8cdbdca826273c77dc9c0fcdc01039e40fad9cfa02df091ba67b3f82ef8933de906dfc32729fc0256daa1ab461076dc726b1299a8dd71cac3552ba4981416b49517c3b39493607f247227f001f8085d986872a3debaaecd9e33d6700ec1f7c5a3bd21eb833a7e18446685f4734419f4d123b7b6f
Nudi, F., Procaccini, E., Versaci, F., Giordano, A., Pinto, A., Neri, G., et al. (2017). Impact of coronary revascularization on the clinical and scintigraphic outlook of patients with myocardial ischemia. JOURNAL OF CARDIOVASCULAR MEDICINE, 18(6), 404-409 [10.2459/JCM.0000000000000506].
Nudi, F; Procaccini, E; Versaci, F; Giordano, A; Pinto, A; Neri, G; Frati, G; Schillaci, O; Nudi, A; Tomai, F; Biondi-Zoccai, G
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/212717
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