title: An initial strategy of intensive medical therapy is comparable to that of coronary revascularization for suppression of scintigraphic ischemia in high-risk but stable survivors of acute myocardial infarction.
abstract: OBJECTIVE
  The purpose of this study was to determine the relative benefit of intensive medical therapy compared with coronary revascularization for suppressing scintigraphic ischemia.
  
  
  BACKGROUND
  Although medical therapies can reduce myocardial ischemia and improve patient survival after acute myocardial infarction, the relative benefit of medical therapy versus coronary revascularization for reducing ischemia is unknown.
  
  
  METHODS
  A prospective randomized trial in 205 stable survivors of acute myocardial infarction was made to define the relative efficacy of an intensive medical therapy strategy versus coronary revascularization for suppressing scintigraphic ischemia as assessed by serial gated adenosine Tc-99m sestamibi myocardial perfusion tomography. All patients at baseline had large total (> or =20%) and ischemic (> or =10%) adenosine-induced left ventricular perfusion defects and an ejection fraction > or =35%. Imaging was performed during 1 to 10 days of hospital admission and repeated in an identical fashion after optimization of therapy. Patients randomized to either strategy had similar baseline demographic and scintigraphic characteristics.
  
  
  RESULTS
  Both intensive medical therapy and coronary revascularization induced significant but comparable reductions in total (-16.2 +/- 10% vs. -17.8 +/- 12%; p = NS) and ischemic (-15 +/- 9% vs. -16.2 +/- 9%; p = NS) perfusion defect sizes. Likewise, a similar percentage of patients randomized to medical therapy versus coronary revascularization had suppression of adenosine-induced ischemia (80% vs. 81%; p = NS).
  
  
  CONCLUSIONS
  Sequential adenosine sestamibi myocardial perfusion tomography can effectively monitor changes in scintigraphic ischemia after anti-ischemic medical or coronary revascularization therapy. A strategy of intensive medical therapy is comparable to coronary revascularization for suppressing ischemia in stable patients after acute infarction who have preserved LV function.
authors.affiliation: Methodist DeBakey Heart Center, Department of Cardiology, The Methodist Hospital, Houston, Texas 77030, USA. jmahmarian@tmh.tmc.edu
authors.forename: John J
authors.initials: JJ
authors.lastname: Mahmarian
authors.forename: Habib A
authors.initials: HA
authors.lastname: Dakik
authors.forename: Neil G
authors.initials: NG
authors.lastname: Filipchuk
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Sherif S
authors.initials: SS
authors.lastname: Iskander
authors.forename: Terrence D
authors.initials: TD
authors.lastname: Ruddy
authors.forename: Felix
authors.initials: F
authors.lastname: Keng
authors.forename: Milena J
authors.initials: MJ
authors.lastname: Henzlova
authors.forename: Adel
authors.initials: A
authors.lastname: Allam
authors.forename: Lemuel A
authors.initials: LA
authors.lastname: Moyé
authors.forename: Craig M
authors.initials: CM
authors.lastname: Pratt
mesh_terms: D000241:Adenosine; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D009204:Myocardial Revascularization; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine