title: Outcome with invasive versus medical treatment of stable coronary artery disease: influence of perfusion defect size, ischaemia, and ejection fraction.
abstract: OBJECTIVE
  Our aim was to address the combined influence of myocardial perfusion defects and left ventricular ejection fraction (LVEF) on outcome with coronary revascularisation in stable CAD patients.
  
  
  RESULTS
  Of 527 patients with ischaemia by myocardial perfusion scintigraphy, 343 had medical therapy (Med) and 184 revascularisation (Revasc). During 5.3 years of follow-up, there was no intergroup difference in rates of death/myocardial infarction. Propensity score adjustment demonstrated a benefit of Revasc over Med with large defects (>14% of the myocardium), marked ischaemia (>10% of the myocardium), or LVEF <50%. However, defect size, ischaemia, and LVEF were correlated. In multivariate models, the Med versus Revasc hazard ratio (HR) was 4.06 times larger for LVEF <50% than for LVEF ≥50% (p=0.04) and 3.01 times larger for marked compared to mild/moderate ischaemia (p=0.11), whereas the effect of large compared to small/moderate defects vanished when adjusted for LVEF and ischaemia (HR=1.01, p=0.99). Considering the outcome difference as a function of both LVEF and ischaemia, we found no advantage or even a disadvantage of revascularisation in patients with mild/moderate ischaemia and preserved LVEF.
  
  
  CONCLUSIONS
  A benefit of revascularisation was found only in case of marked ischaemia or LVEF <50%. For treatment triage, both perfusion parameters and LVEF should be considered.
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Simonsen
authors.forename: Allan
authors.initials: A
authors.lastname: Johansen
authors.forename: Oke
authors.initials: O
authors.lastname: Gerke
authors.forename: Hans
authors.initials: H
authors.lastname: Mickley
authors.forename: Anders
authors.initials: A
authors.lastname: Thomassen
authors.forename: Søren
authors.initials: S
authors.lastname: Hess
authors.forename: Charlotte K
authors.initials: CK
authors.lastname: Rask
authors.forename: Mohammad
authors.initials: M
authors.lastname: Tamadoni
authors.forename: Lisette O
authors.initials: LO
authors.lastname: Jensen
authors.forename: Jesper
authors.initials: J
authors.lastname: Hallas
authors.forename: Werner
authors.initials: W
authors.lastname: Vach
authors.forename: Poul F
authors.initials: PF
authors.lastname: Høilund-Carlsen
mesh_terms: D003324:Coronary Artery Disease / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology*; D013318:Stroke Volume / Q000502:physiology*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*