BACKGROUND: Prior studies with single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) have shown a survival benefit with early revascularization in patients with >10% to 12.5% ischemic myocardium. The relationship among positron emission tomography (PET)-derived extent of ischemia, early revascularization, and survival is unknown. OBJECTIVES: The purpose of this study was to evaluate the association among percent ischemia on PET MPI, revascularization, and survival. METHODS: A total of 16,029 unique consecutive patients who were undergoing Rubidium-82 rest-stress PET MPI from 2010 to 2016 were included. Patients with known cardiomyopathy and nondiagnostic perfusion results were excluded. Percent ischemic myocardium was estimated from a 17-segment model. Propensity scoring was used to account for nonrandomized referral to early revascularization (90 days of PET). A Cox model was developed, adjusting for propensity scores for early revascularization and percent ischemia, and an interaction between ischemia and early revascularization was tested. RESULTS: Median follow-up was 3.7 years. Overall, 1,277 (8%) patients underwent early revascularization and 2,493 (15.6%) died (738 cardiac). Nearly 37% of patients (n = 5,902) had ischemia, with 13.5% (n = 2,160) having ≥10%. In propensity-adjusted analyses, there was a significant interaction between ischemia and early revascularization (p < 0.001 for all-cause and cardiac death), such that patients with greater ischemia had improved survival with early revascularization, with a potential ischemia threshold at 5% (upper limit 95% confidence interval at 10%). There was no differential association between ischemia and early revascularization on death based on history of known coronary artery disease (interaction p = 0.72). CONCLUSIONS: In a contemporary cohort of patients undergoing PET MPI, patients with greater ischemia had a survival benefit from early revascularization. On exploratory analyses, this threshold was lower than that previously reported for SPECT. These findings require future validation in prospective cohorts or trials.
BACKGROUND: Prior studies with single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) have shown a survival benefit with early revascularization in patients with >10% to 12.5% ischemic myocardium. The relationship among positron emission tomography (PET)-derived extent of ischemia, early revascularization, and survival is unknown. OBJECTIVES: The purpose of this study was to evaluate the association among percent ischemia on PET MPI, revascularization, and survival. METHODS: A total of 16,029 unique consecutive patients who were undergoing Rubidium-82 rest-stress PET MPI from 2010 to 2016 were included. Patients with known cardiomyopathy and nondiagnostic perfusion results were excluded. Percent ischemic myocardium was estimated from a 17-segment model. Propensity scoring was used to account for nonrandomized referral to early revascularization (90 days of PET). A Cox model was developed, adjusting for propensity scores for early revascularization and percent ischemia, and an interaction between ischemia and early revascularization was tested. RESULTS: Median follow-up was 3.7 years. Overall, 1,277 (8%) patients underwent early revascularization and 2,493 (15.6%) died (738 cardiac). Nearly 37% of patients (n = 5,902) had ischemia, with 13.5% (n = 2,160) having ≥10%. In propensity-adjusted analyses, there was a significant interaction between ischemia and early revascularization (p < 0.001 for all-cause and cardiac death), such that patients with greater ischemia had improved survival with early revascularization, with a potential ischemia threshold at 5% (upper limit 95% confidence interval at 10%). There was no differential association between ischemia and early revascularization on death based on history of known coronary artery disease (interaction p = 0.72). CONCLUSIONS: In a contemporary cohort of patients undergoing PET MPI, patients with greater ischemia had a survival benefit from early revascularization. On exploratory analyses, this threshold was lower than that previously reported for SPECT. These findings require future validation in prospective cohorts or trials.
Authors: Leslee J Shaw; William S Weintraub; David J Maron; Pamela M Hartigan; Rory Hachamovitch; James K Min; Marcin Dada; G B John Mancini; Sean W Hayes; Robert A O'Rourke; John A Spertus; William Kostuk; Gilbert Gosselin; Bernard R Chaitman; Merill Knudtson; John Friedman; Piotr Slomka; Guido Germano; Eric R Bates; Koon K Teo; William E Boden; Daniel S Berman Journal: Am Heart J Date: 2012-08 Impact factor: 4.749
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: William E Boden; Robert A O'Rourke; Koon K Teo; Pamela M Hartigan; David J Maron; William J Kostuk; Merril Knudtson; Marcin Dada; Paul Casperson; Crystal L Harris; Bernard R Chaitman; Leslee Shaw; Gilbert Gosselin; Shah Nawaz; Lawrence M Title; Gerald Gau; Alvin S Blaustein; David C Booth; Eric R Bates; John A Spertus; Daniel S Berman; G B John Mancini; William S Weintraub Journal: N Engl J Med Date: 2007-03-26 Impact factor: 91.245
Authors: Leslee J Shaw; Manuel D Cerqueira; Maria M Brooks; Andrew D Althouse; Veronica V Sansing; George A Beller; Rodica Pop-Busui; Raymond Taillefer; Bernard R Chaitman; Raymond J Gibbons; Jaekyeong Heo; Ami E Iskandrian Journal: J Nucl Cardiol Date: 2012-04-19 Impact factor: 5.952
Authors: Pim A L Tonino; Bernard De Bruyne; Nico H J Pijls; Uwe Siebert; Fumiaki Ikeno; Marcel van' t Veer; Volker Klauss; Ganesh Manoharan; Thomas Engstrøm; Keith G Oldroyd; Peter N Ver Lee; Philip A MacCarthy; William F Fearon Journal: N Engl J Med Date: 2009-01-15 Impact factor: 91.245
Authors: Robert L Frye; Phyllis August; Maria Mori Brooks; Regina M Hardison; Sheryl F Kelsey; Joan M MacGregor; Trevor J Orchard; Bernard R Chaitman; Saul M Genuth; Suzanne H Goldberg; Mark A Hlatky; Teresa L Z Jones; Mark E Molitch; Richard W Nesto; Edward Y Sako; Burton E Sobel Journal: N Engl J Med Date: 2009-06-07 Impact factor: 91.245
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: Merrill Thomas; Brett W Sperry; Poghni Peri-Okonny; Ali O Malik; A Iain McGhie; Ibrahim M Saeed; Paul S Chan; John A Spertus; Randall C Thompson; Timothy M Bateman; Krishna K Patel Journal: Circ Cardiovasc Imaging Date: 2021-10-19 Impact factor: 8.589
Authors: Peyman N Azadani; Robert J H Miller; Tali Sharir; Marcio A Diniz; Lien-Hsin Hu; Yuka Otaki; Heidi Gransar; Joanna X Liang; Evann Eisenberg; Andrew J Einstein; Mathews B Fish; Terrence D Ruddy; Philipp A Kaufmann; Albert J Sinusas; Edward J Miller; Timothy M Bateman; Sharmila Dorbala; Marcelo Di Carli; Balaji K Tamarappoo; Damini Dey; Daniel S Berman; Piotr J Slomka Journal: JACC Cardiovasc Imaging Date: 2020-08-19
Authors: Ana Gabaldon-Perez; Victor Marcos-Garces; Jose Gavara; Cesar Rios-Navarro; Gema Miñana; Antoni Bayes-Genis; Oliver Husser; Juan Sanchis; Julio Nunez; Francisco Javier Chorro; Vicente Bodi Journal: J Clin Med Date: 2021-02-05 Impact factor: 4.241
Authors: Panagiotis Antiochos; Yin Ge; Kevin Steel; Yi-Yun Chen; Scott Bingham; Shuaib Abdullah; J Ronald Mikolich; Andrew E Arai; W Patricia Bandettini; Amit R Patel; Afshin Farzaneh-Far; John F Heitner; Chetan Shenoy; Steve W Leung; Jorge A Gonzalez; Dipan J Shah; Subha V Raman; Victor A Ferrari; Jeanette Schulz-Menger; Matthias Stuber; Orlando P Simonetti; Venkatesh L Murthy; Raymond Y Kwong Journal: JAMA Cardiol Date: 2020-12-01 Impact factor: 14.676