首页|Benefit of Early Revascularization Based on Inducible Ischemia and Left Ventricular Ejection Fraction
Benefit of Early Revascularization Based on Inducible Ischemia and Left Ventricular Ejection Fraction
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NSTL
Elsevier
? 2022Background: The utility of performing early myocardial revascularization among patients presenting with inducible myocardial ischemia and low left ventricular ejection fraction (LVEF) is currently unknown。 Objectives: In this study， we sought to assess the relationship between stress-induced myocardial ischemia， revascularization， and all-cause mortality (ACM) among patients with normal vs low LVEF。 Methods: We evaluated 43，443 patients undergoing stress-rest single-photon emission computed tomography myocardial perfusion imaging from 1998 to 2017。 Median follow-up was 11。4 years。 Myocardial ischemia was assessed for its interaction between early revascularization and mortality。 A propensity score was used to adjust for nonrandomization to revascularization， followed by multivariable Cox modeling adjusted for the propensity score and clinical variables to predict ACM。 Results: The frequency of myocardial ischemia varied markedly according to LVEF and angina， ranging from 6。7% among patients with LVEF ≥55% and no typical angina to 64。0% among patients with LVEF <45% and typical angina (P < 0。001)。 Among 39，883 patients with LVEF ≥45%， early revascularization was associated with increased mortality risk among patients without ischemia and lower mortality risk among patients with severe (≥15%) ischemia (HR: 0。70; 95% CI: 0。52-0。95)。 Among 3，560 patients with LVEF <45%， revascularization was not associated with mortality benefit among patients with no or mild ischemia， and was associated with decreased mortality among patients with moderate (10%-14%) (HR: 0。67; 95% CI: 0。49-0。91) and severe (≥15%) (HR: 0。55; 95% CI: 0。38-0。80) ischemia。 Conclusions: Within this cohort， early myocardial revascularization was associated with a significant reduction in mortality among both patients with normal LVEF and severe inducible myocardial ischemia and patients with low LVEF and moderate or severe inducible myocardial ischemia。
NSTL
Elsevier
