Mamoru Nanasato1, Naoya Matsumoto2, Kenichi Nakajima3, Taishiro Chikamori4, Masao Moroi5, Kazuya Takehana6, Mitsuru Momose7, Hidetaka Nishina8, Tokuo Kasai9, Shunichi Yoda2, Keisuke Kiso10, Hiroyuki Yamamoto11, Shigeyuki Nishimura12, Akira Yamashina4, Hideo Kusuoka13, Atsushi Hirayama2, Tsunehiko Nishimura14. 1. Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan. Electronic address: nana@nagoya2.jrc.or.jp. 2. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. 3. Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan. 4. Department of Cardiology, Tokyo Medical University, Tokyo, Japan. 5. Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan. 6. Department of Cardiology, Kansai Medical University, Hirakata, Japan. 7. Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan. 8. Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan. 9. Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan. 10. Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan. 11. Department of Cardiology, Okayama Saiseikai General Hospital, Okayama, Japan. 12. Saitama Medical University International Medical Center, Hidaka, Japan. 13. National Hospital Organization, Tokyo, Japan. 14. Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: nisimura@koto.kpu-m.ac.jp.
Abstract
AIM: Whether myocardial ischemia identified using myocardial perfusion imaging (MPI) can be an alternative target of coronary revascularization to reduce the incidence of cardiac events remains unclear. METHODS AND RESULTS: This multicenter, prospective cohort study aimed to clarify the prognostic impact of reducing myocardial ischemia. Among 494 registered patients with possible or definite coronary artery disease (CAD), 298 underwent initial pharmacological stress 99mTc-tetrofosmin MPI before, and eight months after revascularization or medical therapy, and were followed up for at least one year. Among these, 114 with at least 5% ischemia at initial MPI were investigated. The primary endpoints were cardiac death, non-fatal myocardial infarction and hospitalization for heart failure. Ischemia was reduced ≥5% in 92 patients. Coronary revascularization reduced ischemia (n = 89) more effectively than medical therapy (n = 25). Post-stress cardiac function also improved after coronary revascularization. Ejection fraction significantly improved at stress (61.0% ± 10.7% vs. 65.4% ± 11.3%; p < 0.001) but not at rest (67.1% ± 11.3% vs. 68.3% ± 11.6%; p = 0.144), among patients who underwent revascularization. Rates of coronary revascularization and cardiac events among the 114 patients were significantly higher (13.6%, p = 0.035) and lower (1.1% p = 0.0053), respectively, in patients with, than without ≥5% ischemia reduction. Moreover, patients with complete resolution of ischemia at the time of the second MPI had a significantly better prognosis. CONCLUSIONS: Reducing ischemia by ≥5% and the complete resolution of ischemia could improve the prognosis of patients with stable CAD.
AIM: Whether myocardial ischemia identified using myocardial perfusion imaging (MPI) can be an alternative target of coronary revascularization to reduce the incidence of cardiac events remains unclear. METHODS AND RESULTS: This multicenter, prospective cohort study aimed to clarify the prognostic impact of reducing myocardial ischemia. Among 494 registered patients with possible or definite coronary artery disease (CAD), 298 underwent initial pharmacological stress 99mTc-tetrofosmin MPI before, and eight months after revascularization or medical therapy, and were followed up for at least one year. Among these, 114 with at least 5% ischemia at initial MPI were investigated. The primary endpoints were cardiac death, non-fatal myocardial infarction and hospitalization for heart failure. Ischemia was reduced ≥5% in 92 patients. Coronary revascularization reduced ischemia (n = 89) more effectively than medical therapy (n = 25). Post-stress cardiac function also improved after coronary revascularization. Ejection fraction significantly improved at stress (61.0% ± 10.7% vs. 65.4% ± 11.3%; p < 0.001) but not at rest (67.1% ± 11.3% vs. 68.3% ± 11.6%; p = 0.144), among patients who underwent revascularization. Rates of coronary revascularization and cardiac events among the 114 patients were significantly higher (13.6%, p = 0.035) and lower (1.1% p = 0.0053), respectively, in patients with, than without ≥5% ischemia reduction. Moreover, patients with complete resolution of ischemia at the time of the second MPI had a significantly better prognosis. CONCLUSIONS: Reducing ischemia by ≥5% and the complete resolution of ischemia could improve the prognosis of patients with stable CAD.