1. The Relationship Between Quantitative Ischemia, Early Revascularization, and Major Adverse Cardiovascular Events
- Author
-
Robert JH. Miller, MD, Bryan Bednarski, MSc, Yujie Cui, MSc, Vinicius Calsavara, PhD, Krishna Patel, MD, Alan Rozanski, MD, Joanna X. Liang, MPH, Valerie Builoff, BSc, Wanda Acampa, MD, Timothy M. Bateman, MD, Marcelo Di Carli, MD, Sharmila Dorbala, MD, MPH, Andrew J. Einstein, MD, PhD, Matthews B. Fish, MD, M. Timothy Hauser, MD, Philipp A. Kaufmann, MD, Edward J. Miller, MD, PhD, Terrence D. Ruddy, MD, Tali Sharir, MD, Albert J. Sinusas, MD, Damini Dey, PhD, Daniel S. Berman, MD, and Piotr J. Slomka, PhD
- Subjects
cardiovascular events ,ischemia ,revascularization ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Background: Observational data have suggested that patients with moderate to severe ischemia benefit from revascularization. However, this was not confirmed in a large, randomized trial. Objectives: Using a contemporary, multicenter registry, the authors evaluated differences in the association between quantitative ischemia, revascularization, and outcomes across important subgroups. Methods: Patients who underwent myocardial perfusion imaging in 12 centers were included in this retrospective analysis. The population was divided into original (2009-2014) and recent (2014-2021) registry sites. Early revascularization was defined as any revascularization within 90 days of myocardial perfusion imaging. A propensity score was developed to adjust for nonrandomization. Propensity score-adjusted survival analyses were used to evaluate the associations between quantitative ischemia, early revascularization, and death or myocardial infarction (MI) to identify at what severity of ischemia the HR for early revascularization crosses 1 (threshold for potential benefit). Results: Overall, 40,449 patients were included with a median follow-up of 3.5 (IQR: 2.4-4.6) years, during which death or MI occurred in 2,797 (6.9%). Early revascularization was associated with reduced death or MI in patients with >9.0% myocardial ischemia (95% upper CI: 11.2%, interaction P 10.0%) and male patients (>8.6%). Conclusions: Early revascularization was associated with reduced risk in patients with a higher burden of quantitative ischemia in more recent populations. These findings suggest that methods integrating more factors than just ischemia are needed to improve patient selection for revascularization.
- Published
- 2025
- Full Text
- View/download PDF