Francesco Nudi1,2,3, Natale Di Belardino4, Francesco Versaci5,6, Annamaria Pinto1, Enrica Procaccini1, Giandomenico Neri1, Maurizio Vetere1, Giacomo Frati7,8, Mariangela Peruzzi7, Orazio Schillaci9, Achille Gaspardone10, Fabrizio Tomai11, Giuseppe Biondi-Zoccai12,13. 1. Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy. 2. Ostia Radiologica, Rome, Italy. 3. Etisan, Rome, Italy. 4. Division of Cardiology, Anzio-Nettuno Hospital, Anzio, Italy. 5. Department of Cardiovascular Disease, Ospedale A. Cardarelli, Campobasso, Italy. 6. Department of Cardiovascular Disease, Ospedale F. Veneziale, Isernia, Italy. 7. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy. 8. Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. 9. Department of Nuclear Medicine, Tor Vergata University of Rome, Rome, Italy. 10. Division of Cardiology, S. Eugenio Hospital, Rome, Italy. 11. Division of Cardiology, European Hospital, Rome, Italy. 12. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy. gbiondizoccai@gmail.com. 13. Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. gbiondizoccai@gmail.com.
Abstract
BACKGROUND: Randomized trials have challenged the role of revascularization in stable coronary artery disease. We aimed to appraise the impact of revascularization on ischemia in patients undergoing serial myocardial perfusion scintigraphy (MPS). METHODS: We queried our institutional database for stable subjects undergoing serial MPS and appraised the impact of revascularization on changes in ischemia. RESULTS: A total of 3631 patients were included: 967 (27%) undergoing revascularization and 2664 (73%) receiving medical therapy only. Patients treated with revascularization had a significantly lower burden of myocardial ischemia at follow-up (odds ratio = 0.577 [95% confidence interval 0.483-0.689] vs medical therapy, P < .001). Among all those having moderate or severe ischemia at baseline, revascularization was associated with a follow-up prevalence of 80% for no, minimal, or mild ischemia and 20% for moderate or severe ischemia, vs 43% and 57% for medical therapy (P < .001). Even at multivariable analysis and propensity-adjusted, and propensity-matched analyses, revascularization was associated with a significantly lower prevalence of moderate or severe ischemia at follow-up (respectively P < .001, P = .001, and P = .042). CONCLUSIONS: Revascularization appears superior to medical therapy in reducing ischemic burden and normalizing myocardial perfusion among subjects with moderate or severe ischemia at baseline.
BACKGROUND: Randomized trials have challenged the role of revascularization in stable coronary artery disease. We aimed to appraise the impact of revascularization on ischemia in patients undergoing serial myocardial perfusion scintigraphy (MPS). METHODS: We queried our institutional database for stable subjects undergoing serial MPS and appraised the impact of revascularization on changes in ischemia. RESULTS: A total of 3631 patients were included: 967 (27%) undergoing revascularization and 2664 (73%) receiving medical therapy only. Patients treated with revascularization had a significantly lower burden of myocardial ischemia at follow-up (odds ratio = 0.577 [95% confidence interval 0.483-0.689] vs medical therapy, P < .001). Among all those having moderate or severe ischemia at baseline, revascularization was associated with a follow-up prevalence of 80% for no, minimal, or mild ischemia and 20% for moderate or severe ischemia, vs 43% and 57% for medical therapy (P < .001). Even at multivariable analysis and propensity-adjusted, and propensity-matched analyses, revascularization was associated with a significantly lower prevalence of moderate or severe ischemia at follow-up (respectively P < .001, P = .001, and P = .042). CONCLUSIONS: Revascularization appears superior to medical therapy in reducing ischemic burden and normalizing myocardial perfusion among subjects with moderate or severe ischemia at baseline.
Authors: Giuseppe Biondi-Zoccai; Imad Sheiban; Claudio Moretti; Tullio Palmerini; Antonio Marzocchi; Davide Capodanno; Corrado Tamburino; Massimo Margheri; Giuseppe Vecchi; Giuseppe Sangiorgi; Andrea Santarelli; Antonio L Bartorelli; Carlo Briguori; Luigi Vignali; Francesco di Pede; Angelo Ramondo; Massimo Medda; Marco de Carlo; Giovanni Falsini; Alberto Benassi; Cataldo Palmieri; Vincenzo Filippone; Diego Sangiorgi; Fabio Barlocco; Stefano de Servi Journal: Clin Res Cardiol Date: 2010-12-03 Impact factor: 5.460
Authors: Rory Hachamovitch; Alan Rozanski; Leslee J Shaw; Gregg W Stone; Louise E J Thomson; John D Friedman; Sean W Hayes; Ishac Cohen; Guido Germano; Daniel S Berman Journal: Eur Heart J Date: 2011-01-21 Impact factor: 29.983
Authors: D S Berman; H Kiat; J D Friedman; F P Wang; K van Train; L Matzer; J Maddahi; G Germano Journal: J Am Coll Cardiol Date: 1993-11-01 Impact factor: 24.094
Authors: Leslee J Shaw; Daniel S Berman; David J Maron; G B John Mancini; Sean W Hayes; Pamela M Hartigan; William S Weintraub; Robert A O'Rourke; Marcin Dada; John A Spertus; Bernard R Chaitman; John Friedman; Piotr Slomka; Gary V Heller; Guido Germano; Gilbert Gosselin; Peter Berger; William J Kostuk; Ronald G Schwartz; Merill Knudtson; Emir Veledar; Eric R Bates; Benjamin McCallister; Koon K Teo; William E Boden Journal: Circulation Date: 2008-02-11 Impact factor: 29.690
Authors: Ivan Jurić; Emir Fazlibegović; Danijel Pravdić; Boris Starčević; Ante Punda; Dražen Huić; Mustafa Hadžiomerović; Damir Rozić; Marko Martinac; Darko Markota; Mirjana Vasilj; Ivan Vasilj; Anshul Saxena Journal: Clin Med Insights Cardiol Date: 2018-07-23