title: Long-Term Survival Benefit of Coronary Revascularization in Patients Undergoing Stress Myocardial Perfusion Imaging.
abstract: BACKGROUND
  We assessed the relationship between clinical outcome and coronary revascularization according to stress-gated myocardial perfusion single-photon emission computed tomography (MPS) in an observational series of patients with suspected or known coronary artery disease (CAD), on long-term follow-up.
  
  
  RESULTS
  The study group consisted of 2,059 patients. During a median follow-up of 61 months, 184 events occurred (126 cardiac deaths and 58 non-fatal MI). The impact of revascularization during follow-up on event-free survival was evaluated using an extended Cox regression model, adjusting for potential clinical and MPS confounders. Revascularization was treated as a binary non-reversible time-dependent covariate. Predefined interactions tested were: (1) revascularization and summed difference score (SDS); (2) revascularization and post-stress left ventricular (LV) ejection fraction (EF); and (3) SDS and post-stress LVEF. Revascularization had a significant effect on event-free survival (adjusted HR, 0.19; P<0.001). Significant interactions were found between revascularization and SDS (P=0.045), and between LVEF and SDS (P=0.015). The protective effect of revascularization increased as SDS increased. For SDS <6 the reduction in HR was detectable only for reduced LVEF.
  
  
  CONCLUSIONS
  Both the degree of stress-induced ischemia and LVEF predict the effect of revascularization on outcome in patients with suspected or known CAD. The protective effect of revascularization appears to be greater in patients with severe ischemia and preserved LVEF.
authors.affiliation: Department of Translational Medical Sciences, University of Naples Federico II.
authors.forename: Mario
authors.initials: M
authors.lastname: Petretta
authors.forename: Wanda
authors.initials: W
authors.lastname: Acampa
authors.forename: Stefania
authors.initials: S
authors.lastname: Daniele
authors.forename: Emilia
authors.initials: E
authors.lastname: Zampella
authors.forename: Roberta
authors.initials: R
authors.lastname: Assante
authors.forename: Carmela
authors.initials: C
authors.lastname: Nappi
authors.forename: Marco
authors.initials: M
authors.lastname: Salvatore
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D049268:Positron-Emission Tomography; D011859:Radiography; D015996:Survival Rate