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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

Median ischaemia change with treatment. Boxes display median, 25th and 75th centiles. Whiskers display 5th and 95th centiles. LV, left ventricular; Revasc, revascularisation.
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OPENHRT2015000284F3: Median ischaemia change with treatment. Boxes display median, 25th and 75th centiles. Whiskers display 5th and 95th centiles. LV, left ventricular; Revasc, revascularisation.

Mentions: Table 2 presents the ischaemia data at baseline and post-treatment. The total defect size as represented by the summed stress score (SSS) was greater at baseline in the revascularisation group compared with the MT group. At follow-up, the SSS tended be lower than baseline in the revascularisation group and higher than baseline in the MT group. Comparing the SSS at follow-up between the two treatment groups, there was no longer a significant difference. In both groups, there was a significant reduction in ischaemia with therapy (figure 2). However, the revascularisation group experienced a greater reduction in ischaemia compared with the MT group (figure 3). The change in ischaemia differed over the time course of the study with greater reduction in ischaemia after the year 2000 compared with before 2000 (median ischaemia reduction of −2% LV ischaemia (IQR −10 to 1) after the year 2000 vs 0% LV ischaemia (IQR −4 to 2) before 2000, p=0.023). This difference was present in the MT group (p=0.035), but not in the revascularisation group (p=0.85).


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)

Median ischaemia change with treatment. Boxes display median, 25th and 75th centiles. Whiskers display 5th and 95th centiles. LV, left ventricular; Revasc, revascularisation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

OPENHRT2015000284F3: Median ischaemia change with treatment. Boxes display median, 25th and 75th centiles. Whiskers display 5th and 95th centiles. LV, left ventricular; Revasc, revascularisation.
Mentions: Table 2 presents the ischaemia data at baseline and post-treatment. The total defect size as represented by the summed stress score (SSS) was greater at baseline in the revascularisation group compared with the MT group. At follow-up, the SSS tended be lower than baseline in the revascularisation group and higher than baseline in the MT group. Comparing the SSS at follow-up between the two treatment groups, there was no longer a significant difference. In both groups, there was a significant reduction in ischaemia with therapy (figure 2). However, the revascularisation group experienced a greater reduction in ischaemia compared with the MT group (figure 3). The change in ischaemia differed over the time course of the study with greater reduction in ischaemia after the year 2000 compared with before 2000 (median ischaemia reduction of −2% LV ischaemia (IQR −10 to 1) after the year 2000 vs 0% LV ischaemia (IQR −4 to 2) before 2000, p=0.023). This difference was present in the MT group (p=0.035), but not in the revascularisation group (p=0.85).

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