Impact of Ischemia-Guided Revascularization With Myocardial Perfusion Imaging for Patients With Multivessel Coronary Disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:60

Article

Kim, Young-Hak¹  Ahn, Jung-Min¹  Park, Duk-Woo¹  Song, Hae Geun¹  Lee, Jong-Young¹  Kim, Won-Jang¹  Kang, Soo-Jin¹  Lee, Seung-Whan¹  Lee, Cheol Whan¹  Moon, Dae Hyuk²  Chung, Cheol-Hyun¹  Lee, Jae-Won¹  Park, Seong-Wook¹  Park, Seung-Jung¹ 

[1] Univ Ulsan, Coll Med, Asan Med Ctr, Inst Heart, Seoul 138736, South Korea

[2] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Nucl Med, Seoul 138736, South Korea

关键词: bypass surgery;    coronary disease;    myocardial perfusion imaging;    revascularization;    stents;   

DOI  :  10.1016/j.jacc.2012.02.061

来源: Elsevier

【 摘 要 】

Objectives The aim of this study was to evaluate the impact of ischemia-guided (IG) revascularization. Background The importance of IG revascularization has not been well-determined. Methods The outcomes of IG revascularization, in which revascularization was performed in the matched coronary artery with the perfusion abnormality on myocardial perfusion image (MPI), were retrospectively compared with those of non-IG revascularization in a registry of 5,340 patients with multivessel coronary disease comprising 2,587 percutaneous coronary interventions (PCIs) with drug-eluting stents and 2,753 coronary artery bypass graft (CABG) surgeries after adjustment with inverse-probability-of-treatment weighting. Results The MPI was performed in 42.3% of patients, and IG revascularization was performed in 17.3%, including 12.4% in PCI and 21.8% in CABG patients (p < 0.001). The incidence of major adverse cardiac and cerebrovascular events (MACCE) including death, myocardial infarction, stroke, or repeat revascularization was significantly lower in the IG than in the non-IG group (16.2% vs. 20.7%; adjusted hazard ratio [aHR]: 0.73; 95% confidence interval [CI]: 0.60 to 0.88; p = 0.001), primarily driven by the lower repeat revascularization rate (9.9% vs. 22.8%; aHR: 0.66; 95% CI: 0.49 to 0.90; p = 0.009). Subgroup analysis showed that IG reduced the risk of MACCE in PCI (17.4% vs. 22.8%; aHR: 0.59; 95% CI: 0.43 to 0.81; p = 0.001) but not in CABG (16.0% vs. 18.5%; aHR: 0.87; 95% CI: 0.67 to 1.14; p = 0.31) patients. Conclusions Ischemia-guided revascularization with MPI, particularly in PCI-treated patients, seems to decrease the risk of repeat revascularization and MACCE for patients with multivessel disease. (J Am Coll Cardiol 2012; 60: 181- 90) (c) 2012 by the American College of Cardiology Foundation

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