Coronary disease & ACSCohort study
Impact of Positron Emission Tomographic Myocardial Perfusion Imaging on Patient Selection for Revascularization
- Prospective cohort study
- consecutive patients
Authors' conclusion
A lack of augmentation or drop in LVEF with vasodilator stress on PET MPI independently identifies patients who have better survival with revascularization within 90 days post-MPI compared with medical therapy, in absence of prior myocardial infarction or revascularization.
Study context
- Population
- Patients undergoing 82Rb rest/stress positron emission tomography (PET) myocardial perfusion imaging (MPI), January 2010 to January 2016, excluding known cardiomyopathy
- Participants
- 14,649 consecutive patients
- Exposure
- 90-day revascularization vs medical therapy, by PET left ventricular ejection fraction (LVEF) reserve and known coronary artery disease (CAD)
- LVEF-R ≤0n = 3,349
- LVEF-R 1 to 5n = 5,266
- LVEF-R >5n = 6,034
- Outcome
- All-cause death; 3-way interaction of known CAD, LVEF-R and 90-day revascularization
- Follow-up
- Median 3.4 years (IQR: 1.9-5.2 years)
Main finding
As reported in the abstract
Significant 3-way interaction among known CAD, LVEF-R and 90-day revascularization
P = 0.025
Without prior CAD, LVEF-R ≤0 identified survival benefit with 90-day revascularization, independent of percent ischemia and myocardial flow reserve
interaction P = 0.005
Observational data: associations, not effects.
Further findings
LVEF-R and death in known CAD (subgroup)
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| LVEF-R · not prognostic | 0.99 (0.98–1.02) | P = 0.98 | |
| 0.512Hazard ratio (log scale) |
Cohort characteristics and events · median 3.4 years
- Known CAD
- 4,982 (34.0%)
- Ischemia
- 5,396 (36.8%)
- Ischemia ≥10%
- 1,909 [13%]
- Mean LVEF-R
- 4.2% ± 5.7%
- 90-day revascularization
- 1,324 (8.1%)
- Deaths
- 2,192 (15.0%)
Original publication
Summarised from the published abstract; every number is checked against it