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Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction.

Mentz RJ, Fiuzat M, Shaw LK, Farzaneh-Far A, M O'Connor C, Borges-Neto S - Open Heart (2015)

Bottom Line: Nuclear imaging data demonstrate that revascularisation leads to favourable effects on ischaemia burden and improved outcomes compared with medical therapy (MT).The magnitude of ischeamia reduction was greater with revascularisation than with MT alone (median change of -6% vs 0%, p<0.001).Ischaemia worsening on nuclear imaging was associated with reduced risk of death/MI, potentially related to development of ischaemic viable myocardium as opposed to scar tissue.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology , Duke University Medical Center (DUMC) , Durham, North Carolina , USA.

ABSTRACT

Objective: Nuclear imaging data demonstrate that revascularisation leads to favourable effects on ischaemia burden and improved outcomes compared with medical therapy (MT). In patients with heart failure (HF), the effects of MT versus revascularisation on ischaemia change and its independent prognostic significance requires investigation.

Methods: From the Duke Databank, we performed a retrospective analysis of 278 consecutive patients with coronary artery disease (CAD) and ejection fraction (EF) ≤40%, who underwent 2 serial myocardial perfusion scans between 1993 and 2009. Ischaemia change was calculated for patients undergoing MT alone, or revascularisation. Cox proportional hazards regression modelling was used to identify factors associated with death/myocardial infarction (MI).

Results: The magnitude of ischeamia reduction was greater with revascularisation than with MT alone (median change of -6% vs 0%, p<0.001). With revascularisation, more patients experienced ≥5% ischaemia reduction compared with MT (52% vs 25%, p<0.01) and a similar percentage experienced ≥5% ischaemia worsening (13% vs 18%, p=0.37). After risk adjustment, ≥5% ischaemia worsening was associated with decreased death/MI (HR=0.58; 95% CI 0.36 to 0.96).

Conclusions: In patients with HF with CAD, revascularisation improves long-term ischaemia burden compared with MT. Ischaemia worsening on nuclear imaging was associated with reduced risk of death/MI, potentially related to development of ischaemic viable myocardium as opposed to scar tissue.

No MeSH data available.


Related in: MedlinePlus

Study population (CAD, coronary artery disease; LVSD, left ventricular systolic dysfunction; MPS, myocardial perfusion scan; MT, medical therapy; Revasc, revascularisation).
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OPENHRT2015000284F1: Study population (CAD, coronary artery disease; LVSD, left ventricular systolic dysfunction; MPS, myocardial perfusion scan; MT, medical therapy; Revasc, revascularisation).

Mentions: We conducted a retrospective analysis of patients from the Duke Cardiovascular Disease and Nuclear Cardiology Databanks. All patients are followed at 6 months, 1 year and annually thereafter, with recording of major clinical events.11 We identified 278 consecutive patients with angiographically documented CAD and LVSD (ejection fraction (EF) ≤40%), who underwent two serial MPS between 1993 and 2009 (figure 1). All patients had CAD documented by coronary angiography within 180 days of initial MPS.


Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction.

Mentz RJ, Fiuzat M, Shaw LK, Farzaneh-Far A, M O'Connor C, Borges-Neto S - Open Heart (2015)

Study population (CAD, coronary artery disease; LVSD, left ventricular systolic dysfunction; MPS, myocardial perfusion scan; MT, medical therapy; Revasc, revascularisation).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555068&req=5

OPENHRT2015000284F1: Study population (CAD, coronary artery disease; LVSD, left ventricular systolic dysfunction; MPS, myocardial perfusion scan; MT, medical therapy; Revasc, revascularisation).
Mentions: We conducted a retrospective analysis of patients from the Duke Cardiovascular Disease and Nuclear Cardiology Databanks. All patients are followed at 6 months, 1 year and annually thereafter, with recording of major clinical events.11 We identified 278 consecutive patients with angiographically documented CAD and LVSD (ejection fraction (EF) ≤40%), who underwent two serial MPS between 1993 and 2009 (figure 1). All patients had CAD documented by coronary angiography within 180 days of initial MPS.

Bottom Line: Nuclear imaging data demonstrate that revascularisation leads to favourable effects on ischaemia burden and improved outcomes compared with medical therapy (MT).The magnitude of ischeamia reduction was greater with revascularisation than with MT alone (median change of -6% vs 0%, p<0.001).Ischaemia worsening on nuclear imaging was associated with reduced risk of death/MI, potentially related to development of ischaemic viable myocardium as opposed to scar tissue.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology , Duke University Medical Center (DUMC) , Durham, North Carolina , USA.

ABSTRACT

Objective: Nuclear imaging data demonstrate that revascularisation leads to favourable effects on ischaemia burden and improved outcomes compared with medical therapy (MT). In patients with heart failure (HF), the effects of MT versus revascularisation on ischaemia change and its independent prognostic significance requires investigation.

Methods: From the Duke Databank, we performed a retrospective analysis of 278 consecutive patients with coronary artery disease (CAD) and ejection fraction (EF) ≤40%, who underwent 2 serial myocardial perfusion scans between 1993 and 2009. Ischaemia change was calculated for patients undergoing MT alone, or revascularisation. Cox proportional hazards regression modelling was used to identify factors associated with death/myocardial infarction (MI).

Results: The magnitude of ischeamia reduction was greater with revascularisation than with MT alone (median change of -6% vs 0%, p<0.001). With revascularisation, more patients experienced ≥5% ischaemia reduction compared with MT (52% vs 25%, p<0.01) and a similar percentage experienced ≥5% ischaemia worsening (13% vs 18%, p=0.37). After risk adjustment, ≥5% ischaemia worsening was associated with decreased death/MI (HR=0.58; 95% CI 0.36 to 0.96).

Conclusions: In patients with HF with CAD, revascularisation improves long-term ischaemia burden compared with MT. Ischaemia worsening on nuclear imaging was associated with reduced risk of death/MI, potentially related to development of ischaemic viable myocardium as opposed to scar tissue.

No MeSH data available.


Related in: MedlinePlus