The Relationship Between Quantitative Ischemia, Early Revascularization, and Major Adverse Cardiovascular Events: A Multicenter Study

Overview

Journal JACC Adv

Specialty Cardiology & Vascular Diseases

Date 2025 Jan 6

PMID 39759439

Authors

Robert Jh Miller

Bryan Bednarski

Yujie Cui

Vinicius Calsavara

Krishna Patel

Alan Rozanski

Joanna X Liang

Valerie Builoff

Wanda Acampa

Timothy M Bateman

Marcelo Di Carli

Sharmila Dorbala

Andrew J Einstein

Matthews B Fish

M Timothy Hauser

Philipp A Kaufmann

Edward J Miller

Terrence D Ruddy

Tali Sharir

Albert J Sinusas

Damini Dey

Daniel S Berman

Piotr J Slomka

Affiliations

Soon will be listed here.

Abstract

Background: Observational data have suggested that patients with moderate to severe ischemia benefit from revascularization. However, this was not confirmed in a large, randomized trial.

Objectives: Using a contemporary, multicenter registry, the authors evaluated differences in the association between quantitative ischemia, revascularization, and outcomes across important subgroups.

Methods: Patients who underwent myocardial perfusion imaging in 12 centers were included in this retrospective analysis. The population was divided into original (2009-2014) and recent (2014-2021) registry sites. Early revascularization was defined as any revascularization within 90 days of myocardial perfusion imaging. A propensity score was developed to adjust for nonrandomization. Propensity score-adjusted survival analyses were used to evaluate the associations between quantitative ischemia, early revascularization, and death or myocardial infarction (MI) to identify at what severity of ischemia the HR for early revascularization crosses 1 (threshold for potential benefit).

Results: Overall, 40,449 patients were included with a median follow-up of 3.5 (IQR: 2.4-4.6) years, during which death or MI occurred in 2,797 (6.9%). Early revascularization was associated with reduced death or MI in patients with >9.0% myocardial ischemia (95% upper CI: 11.2%, interaction < 0.001). The threshold for ischemia, above which patients may benefit from revascularization, was higher in more recent patients (14.0% vs 6.5%), but similar in female (>10.0%) and male patients (>8.6%).

Conclusions: Early revascularization was associated with reduced risk in patients with a higher burden of quantitative ischemia in more recent populations. These findings suggest that methods integrating more factors than just ischemia are needed to improve patient selection for revascularization.

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