Impact of ischemia-guided revascularization with myocardial perfusion imaging for patients with multivessel coronary disease.
OBJECTIVE
The aim of this study was to evaluate the impact of ischemia-guided (IG) revascularization.


BACKGROUND
The importance of IG revascularization has not been well-determined.


METHODS
The outcomes of IG revascularization, in which revascularization was performed in the matched coronary artery with the perfusion abnormality on myocardial perfusion image (MPI), were retrospectively compared with those of non-IG revascularization in a registry of 5,340 patients with multivessel coronary disease comprising 2,587 percutaneous coronary interventions (PCIs) with drug-eluting stents and 2,753 coronary artery bypass graft (CABG) surgeries after adjustment with inverse-probability-of-treatment weighting.


RESULTS
The MPI was performed in 42.3% of patients, and IG revascularization was performed in 17.3%, including 12.4% in PCI and 21.8% in CABG patients (p < 0.001). The incidence of major adverse cardiac and cerebrovascular events (MACCE) including death, myocardial infarction, stroke, or repeat revascularization was significantly lower in the IG than in the non-IG group (16.2% vs. 20.7%; adjusted hazard ratio [aHR]: 0.73; 95% confidence interval [CI]: 0.60 to 0.88; p = 0.001), primarily driven by the lower repeat revascularization rate (9.9% vs. 22.8%; aHR: 0.66; 95% CI: 0.49 to 0.90; p = 0.009). Subgroup analysis showed that IG reduced the risk of MACCE in PCI (17.4% vs. 22.8%; aHR: 0.59; 95% CI: 0.43 to 0.81; p = 0.001) but not in CABG (16.0% vs. 18.5%; aHR: 0.87; 95% CI: 0.67 to 1.14; p = 0.31) patients.


CONCLUSIONS
Ischemia-guided revascularization with MPI, particularly in PCI-treated patients, seems to decrease the risk of repeat revascularization and MACCE for patients with multivessel disease.
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Young-Hak
YH
Kim
Jung-Min
JM
Ahn
Duk-Woo
DW
Park
Hae Geun
HG
Song
Jong-Young
JY
Lee
Won-Jang
WJ
Kim
Sung-Cheol
SC
Yun
Soo-Jin
SJ
Kang
Seung-Whan
SW
Lee
Cheol Whan
CW
Lee
Dae Hyuk
DH
Moon
Cheol-Hyun
CH
Chung
Jae-Won
JW
Lee
Seong-Wook
SW
Park
Seung-Jung
SJ
Park
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D055414:Myocardial Perfusion Imaging; D011183:Postoperative Complications / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology