title: Impact of coronary revascularization vs medical therapy on ischemia among stable patients with or suspected coronary artery disease undergoing serial myocardial perfusion scintigraphy.
abstract: Randomized trials have challenged the role of revascularization in stable coronary artery disease. We aimed to appraise the impact of revascularization on ischemia in patients undergoing serial myocardial perfusion scintigraphy (MPS).
  
  
  
  We queried our institutional database for stable subjects undergoing serial MPS and appraised the impact of revascularization on changes in ischemia.
  
  
  
  A total of 3631 patients were included: 967 (27%) undergoing revascularization and 2664 (73%) receiving medical therapy only. Patients treated with revascularization had a significantly lower burden of myocardial ischemia at follow-up (odds ratio = 0.577 [95% confidence interval 0.483-0.689] vs medical therapy, P < .001). Among all those having moderate or severe ischemia at baseline, revascularization was associated with a follow-up prevalence of 80% for no, minimal, or mild ischemia and 20% for moderate or severe ischemia, vs 43% and 57% for medical therapy (P < .001). Even at multivariable analysis and propensity-adjusted, and propensity-matched analyses, revascularization was associated with a significantly lower prevalence of moderate or severe ischemia at follow-up (respectively P < .001, P = .001, and P = .042).
  
  
  
  Revascularization appears superior to medical therapy in reducing ischemic burden and normalizing myocardial perfusion among subjects with moderate or severe ischemia at baseline.
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy.|Ostia Radiologica, Rome, Italy.|Etisan, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nudi
authors.affiliation: Division of Cardiology, Anzio-Nettuno Hospital, Anzio, Italy.
authors.forename: Natale
authors.initials: N
authors.lastname: Di Belardino
authors.affiliation: Department of Cardiovascular Disease, Ospedale A. Cardarelli, Campobasso, Italy.|Department of Cardiovascular Disease, Ospedale F. Veneziale, Isernia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Versaci
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Pinto
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Procaccini
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy.
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Neri
authors.affiliation: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vetere
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.|Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Peruzzi
authors.affiliation: Department of Nuclear Medicine, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Schillaci
authors.affiliation: Division of Cardiology, S. Eugenio Hospital, Rome, Italy.
authors.forename: Achille
authors.initials: A
authors.lastname: Gaspardone
authors.affiliation: Division of Cardiology, European Hospital, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy. gbiondizoccai@gmail.com.|Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. gbiondizoccai@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D016017:Odds Ratio; D015995:Prevalence; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Cardiovascular disease; coronary artery bypass grafting; coronary artery disease; maximal ischemia score; myocardial ischemia; myocardial perfusion imaging; myocardial perfusion scintigraphy