Journal
JACC-CARDIOVASCULAR IMAGING
Volume 14, Issue 3, Pages 644-653Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcmg.2020.05.039
Keywords
ischemia; MACE; revascularization
Funding
- National Heart, Lung, and Blood Institute/National Institutes of Health [R01HL089765]
- Miriam and Sheldon Adelson Medical Research Foundation
- Arthur J E Child Fellowship grant
- Toshiba America Medical Systems
- Roche Medical Systems
- GE Healthcare
- Advanced Accelerator Applications
- Bracco Inc.
- Astellas
- Spectrum Dynamics
- HeartFlow
- Siemens Medical Systems
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This study used a contemporary, multicenter international SPECT-MPI registry to investigate the potential benefits of early revascularization based on automatic quantification of ischemia. The results showed that early revascularization of patients with >10.2% ischemia on SPECT-MPI was associated with reduced MACE, indicating its potential benefit for patients with significant ischemia.
OBJECTIVES Using a contemporary, multicenter international single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) registry, this study characterized the potential major adverse cardiovascular event(s) (MACE) benefit of early revascutarization based on automatic quantification of ischemia. BACKGROUND Prior single-center data reported an association between moderate to severe ischemia SPECT-MPI and reduced cardiac death with early revascularization. METHODS Consecutive patients from a multicenter, international registry who underwent (99)mTc SPECT-MPI between 2009 and 2014 with solid-state scanners were included. Ischemia was quantified automatically as ischemic total perfusion deficit (TPD). Early revascularization was defined as within 90 days. The primary outcome was MACE (death, myocardial infarction, and unstable angina). A propensity score was developed to adjust for nonrandomization of revascularization; then, multivariable Cox modeling adjusted for propensity score and demographics was used to predict MACE. RESULTS In total, 19,088 patients were included, with a mean follow-up of 4.7 +/- 1.6 years, during which MACE occurred in 1,836 (9.6%) patients. There was a significant interaction between ischemic TPD modeled as a continuous variable and early revascularization (interaction p value: 0.012). In this model, there was a trend toward reduced MACE in patients with >5.4% ischemic TPD and a significant association with reduced MACE in patients with >10.2% ischemic TPD. CONCLUSIONS In this large, international, multicenter study reflecting contemporary cardiology practice, early revascularization of patients with >10.2% ischemia on SPECT-MPI, quantified automatically, was associated with reduced MACE. (C) 2021 by the American College of Cardiology Foundation.
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