Value of Ischemia and Coronary Anatomy in Prognosis and Guiding Revascularization Among Patients With Stable Ischemic Heart Disease
Authors' conclusion
Ischemic burden provides independent and incremental prognostic value beyond CAD anatomy and identifies patients who benefit from early revascularization. The anatomic extent of disease has independent prognostic value over clinical risk factors but offers limited incremental benefit for prognosis and guiding revascularization beyond physiological severity (ischemia).
Study context
- Population
- Patients with stable coronary artery disease (CAD) who had rest-stress CZT SPECT myocardial perfusion imaging and angiography (invasive or CT)
- Participants
- 1,764 patients
- Exposure
- Ischemia vs coronary anatomy for prognosis and guiding revascularization
- Outcome
- Cardiac death/nonfatal MI
- Follow-up
- 4.6-year median
Main finding
As reported in the abstract
Cardiac death/MI
Estimate (95% CI)P value
%ischemiamodel containing both ischemia and anatomy
HR per 5% ↑ 1.35(1.11–1.63)
P = 0.002CADPImodel containing both ischemia and anatomy
HR per 10-unit ↑ 1.09(0.99–1.20)
P = 0.07- %Ischemia and single-photon emission computed tomography variables vs clinical risk and CAD prognostic index (CADPI) · incremental prognostic value
- net reclassification index 20.3% (95% CI 9%–32%); P < 0.05
- CADPI vs pretest risk, %ischemia, and single-photon emission computed tomography variables · not incrementally prognostic
- net reclassification index 3.1% (95% CI −5% to 15%); P = 0.21
- Both %ischemia and CADPI provided independent and incremental prognostic value over pretest clinical risk
- P < 0.001
- Cardiac death/MI events
- 148 (8.4%)
Observational data: associations, not effects.
Original publication
Value of Ischemia and Coronary Anatomy in Prognosis and Guiding Revascularization Among Patients With Stable Ischemic Heart Disease. Circ Cardiovasc Imaging. Published 9 September 2024. doi:10.
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