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Extent of Myocardial Ischemia on Positron Emission Tomography and Survival Benefit With Early Revascularization.
- Source :
-
Journal of the American College of Cardiology (JACC) . Oct2019, Vol. 74 Issue 13, p1645-1654. 10p. - Publication Year :
- 2019
-
Abstract
- <bold>Background: </bold>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.<bold>Objectives: </bold>The purpose of this study was to evaluate the association among percent ischemia on PET MPI, revascularization, and survival.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 74
- Issue :
- 13
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 138816876
- Full Text :
- https://doi.org/10.1016/j.jacc.2019.07.055