The Relationship Between Quantitative Ischemia, Early Revascularization, and Major Adverse Cardiovascular Events: A Multicenter Study.

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  < 0.001). The threshold for ischemia, above which patients may benefit from revascularization, was higher in more recent patients (14.0% vs 6.5%), but similar in female (>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.
Competing Interests: This research was supported in part by the National Heart, Lung, and Blood Institute at the National Institutes of Health (grant numbers R01HL089765, R35HL161195) to Dr Slomka The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Robert Miller received consulting fees and research support from Pfizer. Drs Berman and Slomka participate in software royalties for QPS software at Cedars-Sinai Medical Center. Dr Slomka has received research grant support from Siemens Medical Systems and consulting fees for Synektik, SA. Drs Berman, Dorbala, Einstein, and Edward Miller have served or currently serve as consultants for GE Healthcare. Dr Einstein has received speaker fees from Ionetix; has received consulting fees from W. L. Gore & Associates; has received authorship fees from Wolters Kluwer Healthcare–UpToDate; and has received grants to his institution from Attralus, Canon Medical Systems, Eidos Therapeutics, Pfizer, Roche Medical Systems, W. L. Gore & Associates, and XyloCor Therapeutics. Dr Dorbala has served as a consultant to Bracco Diagnostics; her institution has received grant support from Astellas. Dr Di Carli has received research grant support from Spectrum Dynamics and consulting honoraria from Sanofi and GE Healthcare. Dr Ruddy has received research grant support from GE Healthcare and Advanced Accelerator Applications. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2024 The Authors.)