Article Text

Original research article
Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction
  1. Robert J Mentz1,
  2. Mona Fiuzat2,
  3. Linda K Shaw3,
  4. Afshin Farzaneh-Far4,
  5. Christopher M O'Connor1 and
  6. Salvador Borges-Neto5
  1. 1Division of Cardiology, Duke University Medical Center (DUMC), Durham, North Carolina, USA
  2. 2Division of Clinical Pharmacology, DUMC, Durham, North Carolina, USA
  3. 3Duke Clinical Research Institute, Durham, North Carolina, USA
  4. 4Section of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
  5. 5Department of Radiology, DUMC, Durham, North Carolina, USA
  1. Correspondence to Dr Robert J Mentz; Robert.mentz{at}duke.edu

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.

  • CORONARY ARTERY DISEASE
  • MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)

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