title: Impact of coronary revascularization on the clinical and scintigraphic outlook of patients with myocardial ischemia.
abstract: OBJECTIVE
  The impact of coronary revascularization on outcomes and ischemic burden among patients with objective proof of ischemia is not yet established. We appraised the impact of revascularization on outcomes and residual ischemia in patients with objective evidence of ischemia at myocardial perfusion scintigraphy (MPS).
  
  
  METHODS
  We queried our database for stable patients with myocardial ischemia at MPS, excluding those with prior myocardial infarction, systolic dysfunction, or cardiomyopathy. The impact of revascularization (defined as revascularization as first follow-up event) on outcomes and changes in myocardial ischemia at repeat MPS was appraised with propensity-matched analyses.
  
  
  RESULTS
  From 6195 patients, propensity matching yielded 1262 pairs of patients undergoing revascularization versus not undergoing revascularization. After 35.2 ± 23.9 months, revascularization was associated with lower risks of cardiac death [2 (0.2%) versus 10 (0.8%) in those not revascularized, P = 0.038] and of the composite of cardiac death or myocardial infarction [17 (1.3%) versus 37 (2.9%), P = 0.007]. In addition, revascularization was associated with a higher rate of improvement in ischemia degree after 28.1 ± 20.7 months of follow-up (P < 0.001), with 257 (69.3%) patients with moderate or severe ischemia at baseline MPS improving after revascularization versus 136 (42.0%) in the nonrevascularization group. Conversely, revascularization did not prove impactful on follow-up MPS in patients with only minimal or mild ischemia at baseline MPS (P < 0.001).
  
  
  CONCLUSIONS
  In a large series of patients with objective evidence of myocardial ischemia at MPS, especially when moderate or severe, revascularization was associated with a better clinical prognosis and a lower ischemic burden at repeat MPS.
authors.affiliation: aService of Nuclear Cardiology, Madonna della Fiducia Clinic bOstia Radiologica cEtisan, Rome dDivision of Cardiology, S. Maria Goretti Hospital, Latina, Italy eInstitute of Nuclear Medicine, Catholic University, Rome fDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina gDepartment of AngioCardioNeurology, IRCCS Neuromed, Pozzilli hDepartment of Nuclear Medicine, Tor Vergata University of Rome iDivision of Cardiology, European Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nudi
authors.forename: Enrica
authors.initials: E
authors.lastname: Procaccini
authors.forename: Francesco
authors.initials: F
authors.lastname: Versaci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
authors.forename: Annamaria
authors.initials: A
authors.lastname: Pinto
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Neri
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Orazio
authors.initials: O
authors.lastname: Schillaci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nudi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
mesh_terms: D000368:Aged; D005080:Exercise Test; D005260:Female; D006801:Humans; D007558:Italy; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery*; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D013997:Time Factors