Outcome of medical versus invasive treatment strategies for non-high-risk ischemic heart disease.
The purpose of this study was to evaluate the outcomes of medical management compared with invasive management for patients with mild or moderate ischemia (non-high-risk) on stress tomographic myocardial perfusion scintigraphy. Of the 1,352 non-high-risk patients, 116 (9%) subsequently were referred for coronary angiography within the first 30 days after the scan; 99 (85%) of this group also underwent early revascularization procedures. The remaining 1,236 patients (91%) with non-high-risk ischemia did not undergo early invasive management. Unadjusted actuarial 3-year rate of cardiac death or nonfatal infarction was significantly better estimated survival in the medically managed group (2%) compared with the invasively managed group (22%), p = 0.0001. Subsequent coronary revascularization procedures during 3-year follow-up were less frequent in the medically managed group (4%) than in the invasively managed group (42%), p = 0.0001. A multivariable analysis identified invasive management strategy (p = 0.0001) as the only correlate of cardiac events during follow-up. In summary, this study showed that patients with non-high-risk ischemia on stress perfusion imaging can be treated safely with a conservative medical management strategy.
O'Keefe
J H
JH
Cardiovascular Consultants, PC, Mid America Heart Institute, Kansas City, Missouri, USA.
Bateman
T M
TM
Ligon
R W
RW
Case
J
J
Cullom
J
J
Barnhart
C
C
Spertus
J
J
D000206:Actuarial Analysis; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon