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Impact of repeat myocardial revascularization on outcome in patients with silent ischemia after previous revascularization

Citation

Aldweib, N and Negishi, K and Hachamovitch, R and Jaber, WA and Seicean, S and Marwick, TH, Impact of repeat myocardial revascularization on outcome in patients with silent ischemia after previous revascularization, Journal of the American College of Cardiology, 61, (15) pp. 1616-1623. ISSN 0735-1097 (2013) [Refereed Article]

Copyright Statement

Copyright 2013 by the American College of Cardiology Foundation

DOI: doi:10.1016/j.jacc.2013.01.043

Abstract

Objectives: This study sought to compare the survival of asymptomatic patients with previous revascularization and ischemia, who subsequently underwent repeat revascularization or medical therapy (MT).

Background: Coronary artery disease is progressive and recurring; thus, stress myocardial perfusion scintigraphy (MPS) is widely used to identify ischemia in patients with previous revascularization.

Methods: Of 6,750 patients with previous revascularization undergoing MPS between January 1, 2005, and December 31, 2007, we identified 769 patients (age 67.7 9.5 years; 85% men) who had ischemia and were asymptomatic. A propensity score was developed to express the associations of revascularization. Patients were followed up over a median of 5.7 years (interquartile range: 4.7 to 6.4 years) for all-cause death. A Cox proportional hazards model was used to identify the association of revascularization with all-cause death, with and without adjustment for the propensity score. The model was repeated in propensity-matched groups undergoing MT versus revascularization.

Results: Among 769 patients, 115 (15%) underwent revascularization a median of 13 days (interquartile range: 6 to 31 days) after MPS. There were 142 deaths; mortality with MT and revascularization were 18.3% and 19.1% (p = 0.84). In a Cox proportional hazards model (chi-square test = 89.4) adjusting for baseline characteristics, type of previous revascularization, MPS data, and propensity scores, only age and hypercholesterolemia but not revascularization were associated with mortality. This result was confirmed in a propensity-matched group.

Conclusions: Asymptomatic patients with previous revascularization and inducible ischemia on MPS realize no survival benefit from repeat revascularization. In this group of post-revascularization patients, an ischemia-based treatment strategy did not alter mortality.

Item Details

Item Type:Refereed Article
Keywords:ischemia, outcome, revascularization, SPECT
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Negishi, K (Dr Kazuaki Negishi)
Author:Marwick, TH (Professor Tom Marwick)
ID Code:84744
Year Published:2013
Web of Science® Times Cited:16
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-05-29
Last Modified:2015-07-30
Downloads:0

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