Original articlePredicting therapeutic benefit from myocardial revascularization procedures: Are measurements of both resting left ventricular ejection fraction and stress-induced myocardial ischemia necessary?
Section snippets
Study Population
We identified 8253 consecutive unique patients who underwent exercise or adenosine gated MPS between June 1994 and February 1999 at Cedars-Sinai Medical Center (Los Angeles, Calif). Of these, 5644 (68%) had no prior coronary revascularization, known valvular disease, or nonischemic cardiomyopathy. Successful follow-up was completed in 95.1% of these patients, leaving a final study population of 5366 patients who were followed up for a mean of 2.8 ± 1.2 years. Patients were separated into 2
Patient Characteristics
Comparison of baseline characteristics of the 4964 patients treated medically and the 402 patients treated with early revascularization revealed multiple differences (Table 1), with the latter being “sicker.” They were older, were more likely to have had prior MI, and more frequently had hypertension, diabetes, anginal symptoms, dyspnea, and an abnormal rest electrocardiogram. Patients without prior MI had a significantly lower likelihood of CAD or ischemia than those with prior MI (median
Discussion
Our central goal was to determine whether the gated MPS measures of stress perfusion and poststress LV EF predicted which patients would accrue a survival benefit with revascularization versus medical therapy after stress MPS in an observational series of patients treated either medically or with revascularization after stress MPS. The unadjusted risk of cardiovascular death increased exponentially as a function of both decreasing EF and increasing percent ischemic myocardium. After adjustment
Acknowledgment
Various nuclear medicine hardware and software manufactures have an agreement with Cedars-Sinai Medical Center, through which the Medical Center receives royalties based on the distribution of the quantitative gated SPECT software. A portion of these royalties is shared by Drs Berman and Germano.
References (33)
- et al.
ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina)
J Am Coll Cardiol
(1999) - et al.
Long-term prognostic value of exercise testing in men and women from the Coronary Artery Surgery Study (CASS) registry
Am J Cardiol
(1995) - et al.
The role of exercise testing in identifying patients with improved survival after coronary artery bypass surgery
J Am Coll Cardiol
(1986) - et al.
Separate acquisition rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion single-photon emission computed tomography: a clinical validation study
J Am Coll Cardiol
(1993) - et al.
Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography
J Am Coll Cardiol
(1995) - et al.
Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease
J Am Coll Cardiol
(1986) - et al.
Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration
Lancet
(1994) - et al.
Value of exercise testing in determining the risk classification and the response to coronary artery bypass grafting in three-vessel coronary artery disease: a report from the Coronary Artery Surgery Study (CASS) registry
Am J Cardiol
(1987) - et al.
Prognostic indicators from radionuclide angiography in medically treated patients with coronary artery disease
Am J Cardiol
(1984) - et al.
Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms
J Am Coll Cardiol
(1997)