Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging
RESEARCH|Updated:2026-03-12
|
Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging
Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging
MMR2017年4卷第3期 页码:127-131
Affiliations:
1.Malcom Randall VAMC, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Box 111-D, Gainesville, FL, USA
2.Division of Cardiovascular Medicine, University of Florida College of Medicine, Malcom Randall VAMC, 1601 SW Archer Rd, Box 111-D, Gainesville, FL, USA
3.Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
4.Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, FL, USA
5.Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
Author bio:
*: david.winchester@va.gov
Funds:
the North Florida/South Georgia Veterans Health System in Gainesville, Florida
Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging[J]. MMR, 2017,4(3):127-131.
Winchester et al.: Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging. Mil Med Res, 2017, 4: 12
Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging[J]. MMR, 2017,4(3):127-131. DOI: 10.1186/s40779-017-0121-x.
Winchester et al.: Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging. Mil Med Res, 2017, 4: 12 DOI: 10.1186/s40779-017-0121-x.
Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging
The prevalence of ischemia on nuclear myocardial perfusion imaging (MPI) has been decreasing. Recent research has questioned the benefit of invasive revascularization for patients with moderate to severe ischemia. We hypothesized that patients with moderate to severe ischemia could routinely undergo successful revascularization.
Methods:
2
We analyzed data from 544 patients who underwent an MPI at a single academic Veterans Affairs Medical Center. Patients with moderate to severe ischemia
defined as a summed difference score (SDS) 8 or greater
were compared to the rest of the cohort.
Results:
2
Of the total cohort (
n
=544)
39 patients had MPI studies with resultant moderate to severe ischemia. Patients with ischemia were more likely to develop coronary artery disease (74.4% versus 38.8%
P
<
0.0001) and have successful revascularization (38.5% versus 4.0%
P
<
0.0001) during the following year. Revascularization was attempted in 31 patients with moderate to severe ischemia
though only 15(47%) of these attempts were successful. Ischemia was predictive of myocardial infarction (5.1% versus 0.8%
P
=0.01) within 1 year.
Conclusion:
2
Moderate to severe ischemia is an uncommon finding in a contemporary nuclear laboratory. Among patients with ischemia
revascularization is typically attempted but is frequently unsuccessful.
Trial registration:
2
This trial does not appear on a registry as it is neither randomized nor prospective.
关键词
Keywords
references
Jaarsma C , Leiner T , Bekkers SC , Crijns HJ , Wildberger JE , Nagel E , et al . Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a meta-analysis . J Am Coll Cardiol . 2012 ; 59 : 1719 - 28 .
Metz LD , Beattie M , Hom R , Redberg RF , Grady D , Fleischmann KE . The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis . J Am Coll Cardiol . 2007 ; 49 : 227 - 37 .
Hachamovitch R , Berman DS , Kiat H , Cohen I , Cabico JA , Friedman J , et al . Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification . Circulation . 1996 ; 93 : 905 - 14 .
Boden WE , O'Rourke RA , Teo KK , Hartigan PM , Maron DJ , Kostuk WJ , et al . Optimal medical therapy with or without PCI for stable coronary disease . N Engl J Med . 2007 ; 356 : 1503 - 16 .
Frye RL , August P , Brooks MM , Hardison RM , Kelsey SF , MacGregor JM , et al . A randomized trial of therapies for type 2 diabetes and coronary artery disease . N Engl J Med . 2009 ; 360 : 2503 - 15 .
Phillips LM , Hachamovitch R , Berman DS , Iskandrian AE , Min JK , Picard MH , et al . Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA . J Nucl Cardiol . 2013 ; 20 : 969 - 75 .
International Study of Comparative Health Effectiveness with Medical and Invasive Approaces (ISCHEMIA) . ClinicalTrials.gov NCT01471522 . https://clinicaltrials.gov/ct2/show/NCT01471522 https://clinicaltrials.gov/ct2/show/NCT01471522 . Accessed 8 Oct 2015 .
Hilliard AA , From AM , Lennon RJ , Singh M , Lerman A , Gersh BJ , et al . Percutaneous revascularization for stable coronary artery disease temporal trends and impact of drug-eluting stents . JACC Cardiovasc Interv . 2010 ; 3 : 172 - 9 .
Tilkemeier PL , Cooke CD , Ficaro EP , Glover DK , Hansen CL , McCallister Jr BD , et al . American Society of Nuclear Cardiology information statement: Standardized reporting matrix for radionuclide myocardial perfusion imaging . J Nucl Cardiol . 2006 ; 13 : e157 - 71 .
von Elm E , Altman DG , Egger M , Pocock SJ , Gotzsche PC , Vandenbroucke JP . The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies . Ann Intern Med . 2007 ; 147 : 573 - 7 .
Rozanski A , Gransar H , Hayes SW , Min J , Friedman JD , Thomson LE , et al . Temporal trends in the frequency of inducible myocardial ischemia during cardiac stress testing: 1991 to 2009 . J Am Coll Cardiol . 2013 ; 61 : 1054 - 65 .
Beller GA . Tests that may be overused or misused in cardiology: the Choosing Wisely campaign . J Nucl Cardiol . 2012 ; 19 : 401 - 3 .
Wolk MJ , Bailey SR , Doherty JU , Douglas PS , Hendel RC , Kramer CM , et al . ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons . J Am Coll Cardiol . 2014 ; 63 : 380 - 06 .
Rothberg MB , Sivalingam SK , Ashraf J , Visintainer P , Joelson J , Kleppel R , et al . Patients’ and cardiologists’ perceptions of the benefits of percutaneous coronary intervention for stable coronary disease . Ann Intern Med . 2010 ; 153 : 307 - 13 .
Coylewright M , Shepel K , Leblanc A , Pencille L , Hess E , Shah N , et al . Shared decision making in patients with stable coronary artery disease: PCI choice . PLoS ONE . 2012 ; 7 : e49827 .
Gupta AK , Winchester D , Pepine CJ . Antagonist molecules in the treatment of angina . Expert Opin Pharmacother . 2013 ; 14 : 2323 - 42 .
The trial reading is over, you can activate your VIP account to continue reading.
Retrospective analysis of US veterans with inclusion body myositis: initial findings from the Veterans Affairs Corporate Data Warehouse
Poor sleep and decreased cortical thickness in veterans with mild traumatic brain injury and post-traumatic stress disorder
Cognitive function among military veterans with STEM occupations
Self-reported physical functioning, cardiometabolic health conditions, and health care utilization patterns in Million Veteran Program enrollees with Traumatic Brain Injury Screening and Evaluation Program data
相关作者
Vladimir M. Liarski
Catherine B. Fortier
Regina E. McGlinchey
William P. Milberg
David H. Salat
Murray J. Andrews
Vladimir M. Liarski
Kevin N. Hascup
相关机构
Department of Medicine, Division of Rheumatology and Clinical Immunology & Department of Immunology, University of Pittsburgh
Department of Medicine, Medicine Service Line-Rheumatology, VA Pittsburgh Health Care System, University Drive Campus
Anthinoula A. Martinos Center for Biomedical Imaging
Neuroimaging Research for Veterans Center, VA Boston Healthcare System
Department f Psychiatry, Boston University School of Medicine