Prognostic impact of reducing myocardial ischemia identified using ECG-gated myocardial perfusion SPECT in Japanese patients with coronary artery disease: J-ACCESS 4 study. (15th September 2018)

• Record Type: Journal Article
• Authors: Nanasato, Mamoru; Matsumoto, Naoya; Nakajima, Kenichi; Chikamori, Taishiro; Moroi, Masao; Takehana, Kazuya; Momose, Mitsuru; Nishina, Hidetaka; Kasai, Tokuo; Yoda, Shunichi; Kiso, Keisuke; Yamamoto, Hiroyuki; Nishimura, Shigeyuki; Yamashina, Akira; Kusuoka, Hideo; Hirayama, Atsushi; Nishimura, Tsunehiko
• Is Part Of: International journal of cardiology. Volume 267(2018)
• Page Start: 202
• Page End: 207
• Publication Date: 2018-09-15
• Subjects: Revascularization -- Left ventricular function -- Scintigraphy -- Prognosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.05.090
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aim: Whether myocardial ischemia identified using myocardial perfusion imaging (MPI) can be an alternative target of coronary revascularization to reduce the incidence of cardiac events remains unclear. Methods and results: This multicenter, prospective cohort study aimed to clarify the prognostic impact of reducing myocardial ischemia. Among 494 registered patients with possible or definite coronary artery disease (CAD), 298 underwent initial pharmacological stress 99m Tc-tetrofosmin MPI before, and eight months after revascularization or medical therapy, and were followed up for at least one year. Among these, 114 with at least 5% ischemia at initial MPI were investigated. The primary endpoints were cardiac death, non-fatal myocardial infarction and hospitalization for heart failure. Ischemia was reduced ≥5% in 92 patients. Coronary revascularization reduced ischemia ( n = 89) more effectively than medical therapy ( n = 25). Post-stress cardiac function also improved after coronary revascularization. Ejection fraction significantly improved at stress (61.0% ± 10.7% vs. 65.4% ± 11.3%; p < 0.001) but not at rest (67.1% ± 11.3% vs. 68.3% ± 11.6%; p = 0.144), among patients who underwent revascularization. Rates of coronary revascularization and cardiac events among the 114 patients were significantly higher (13.6%, p = 0.035) and lower (1.1% p = 0.0053), respectively, in patients with, than without ≥5% ischemia reduction. Moreover, patients with complete resolution of ischemia at the time of the second MPI had a significantly better prognosis. Conclusions: Reducing ischemia by ≥5% and the complete resolution of ischemia could improve the prognosis of patients with stable CAD. Highlights: Myocardial perfusion imaging stratifies risk of cardiac events in the Japanese. Reducing myocardial ischemia >5% improves prognosis. Patients with complete resolution of myocardial ischemia have fewer cardiac events. Coronary revascularization restores left ventricular function at stress and rest.