Abstract 12881: Coronary Revascularization Does Not Decrease Cardiac Events in Patients with Stable Ischemic Heart Disease but Might Do in Those Who Showed Moderate to Severe Ischemia
Background: As an initial management strategy for stable ischemic heart disease (IHD), adding coronary revascularization is not thought to be superior to optimal medical therapy alone regarding prognosis.
Methods: We compared the effects of revascularization on the prognosis of patients with stable IHD who had moderate to severe ischemia with those who had mild or no ischemia detected by nuclear stress imaging. This retrospective study analyzed data from 4,629 patients with suspected or known IHD who underwent gated stress myocardial-perfusion SPCT at 117 hospitals in Japan. The follow-up periods were three years and the endpoints were cardiac death, nonfatal myocardial infarction, and congestive heart failure requiring hospitalization. After matching propensity scores between patients who underwent early revascularization and those who did not (n = 316 per group), we compared cardiac event rates in relation to the amount of ischemic myocardium.
Results: Cardiac event rates did not significantly differ between adjusted patients who underwent early revascularization and those who did not (5.4% vs. 6.4%). Among patients with ≤5%, 6–10%, and >10% ischemic myocardium, cardiac event rates were 8%, 3% and 0% respectively, who underwent early revascularization compared with 4.5%, 6.1%, and 12.3%, respectively, among those who did not. Cardiac event rates were significantly lower among patients with >10% ischemic myocardium who underwent early revascularization compared with those who did not (0% vs. 12.3%, p = 0.0062).
Conclusions: Coronary revascularization for stable IHD does not decrease major cardiac events in all patients but might do in patients with moderate to severe ischemia.
- © 2010 by American Heart Association, Inc.