International journal of cardiology · 2018
Comparison of long-term clinical outcomes between revascularization versus medical treatment in patients with silent myocardial ischemia.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Choi Ki Hong, Lee Joo Myung, Park Il, Kim Jihoon, Rhee Tae-Min, Hwang Doyeon, Park Jonghanne, Park Taek Kyu, Yang Jeong Hoon, Song Young Bin, Hahn Joo-Yong, Jeong Dong Seop, Cho Yang Hyun, Kim Wook Sung, Sung Kiick, Jang Mi Ja, Sung Ji Dong, Choi Jin-Ho, Choi Seung-Hyuk, Koo Bon-Kwon, Lee Young Tak, Kim Eun Kyoung, Chang Sung A, Park Sung-Ji, Choi Jin-Oh, Lee Sang-Chol, Park Seung Woo, Cho Young Seok, Choi Joon Young, Gwon Hyeon-Cheol, Oh Jae K
Аннотация
BACKGROUND: There have been limited and conflicting results regarding the prognostic impact of revascularization treatment on the long-term clinical outcomes of silent ischemia. The current study aimed to determine whether revascularization treatment compared with medical treatment (MT) alone reduces long-term risk of cardiac death of asymptomatic patients with objective evidence of inducible myocardial ischemia.
METHODS: A total of 1473 consecutive asymptomatic patients with evidence of inducible myocardial ischemia were selected from a prospective institutional registry. All patients showed at least 1 epicardial coronary stenosis with ≥50% diameter stenosis in coronary angiography. Patients were classified according to their treatment strategies. The primary outcome was cardiac death up to 10 years.
RESULTS: Among the total population, 709 patients (48.1%) received revascularization treatment including percutaneous coronary intervention (PCI, n = 558) or coronary artery bypass graft surgery (CABG, n = 151), with the remaining patients (764 patients, 51.9%) receiving MT alone. During the follow-up period, the revascularization treatment group showed a significantly lower risk of cardiac death compared with the MT alone group (25.4% vs. 33.7%, HR 0.624, 95%CI 0.498-0.781, p < 0.001). Among revascularized patients, patients with negative non-invasive stress test results after revascularization showed significantly lower risk of cardiac death compared to those with residual myocardial ischemia (8.9% vs. 18.7%, HR 0.406, 95% CI 0.175-0.942, p = 0.036).
CONCLUSIONS: In patients with silent myocardial ischemia, revascularization treatment was associated with significantly lower long-term risk of cardiac death compared with the MT alone group. The current results support contemporary practice of ischemia-directed revascularization, even in patients with silent myocardial ischemia.
METHODS: A total of 1473 consecutive asymptomatic patients with evidence of inducible myocardial ischemia were selected from a prospective institutional registry. All patients showed at least 1 epicardial coronary stenosis with ≥50% diameter stenosis in coronary angiography. Patients were classified according to their treatment strategies. The primary outcome was cardiac death up to 10 years.
RESULTS: Among the total population, 709 patients (48.1%) received revascularization treatment including percutaneous coronary intervention (PCI, n = 558) or coronary artery bypass graft surgery (CABG, n = 151), with the remaining patients (764 patients, 51.9%) receiving MT alone. During the follow-up period, the revascularization treatment group showed a significantly lower risk of cardiac death compared with the MT alone group (25.4% vs. 33.7%, HR 0.624, 95%CI 0.498-0.781, p < 0.001). Among revascularized patients, patients with negative non-invasive stress test results after revascularization showed significantly lower risk of cardiac death compared to those with residual myocardial ischemia (8.9% vs. 18.7%, HR 0.406, 95% CI 0.175-0.942, p = 0.036).
CONCLUSIONS: In patients with silent myocardial ischemia, revascularization treatment was associated with significantly lower long-term risk of cardiac death compared with the MT alone group. The current results support contemporary practice of ischemia-directed revascularization, even in patients with silent myocardial ischemia.
Предметные рубрики MeSH
AgedAsymptomatic DiseasesCoronary Artery BypassFemaleFollow-Up StudiesHumansMaleMiddle AgedMortalityMyocardial IschemiaMyocardial RevascularizationPercutaneous Coronary InterventionPlatelet Aggregation InhibitorsProspective StudiesRegistriesTomography, Emission-Computed, Single-PhotonTreatment Outcome