title: Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging.
abstract: The prevalence of ischemia on nuclear myocardial perfusion imaging (MPI) has been decreasing. Recent research has questioned the benefit of invasive revascularization for patients with moderate to severe ischemia. We hypothesized that patients with moderate to severe ischemia could routinely undergo successful revascularization.
  
  
  
  We analyzed data from 544 patients who underwent an MPI at a single academic Veterans Affairs Medical Center. Patients with moderate to severe ischemia, defined as a summed difference score (SDS) 8 or greater, were compared to the rest of the cohort.
  
  
  
  Of the total cohort (n= 544), 39 patients had MPI studies with resultant moderate to severe ischemia. Patients with ischemia were more likely to develop coronary artery disease (74.4% versus 38.8%,P< 0.0001) and have successful revascularization (38.5% versus 4.0%,P< 0.0001) during the following year. Revascularization was attempted in 31 patients with moderate to severe ischemia, though only 15 (47%) of these attempts were successful. Ischemia was predictive of myocardial infarction (5.1% versus 0.8%,P= 0.01) within 1 year.
  
  
  
  Moderate to severe ischemia is an uncommon finding in a contemporary nuclear laboratory. Among patients with ischemia, revascularization is typically attempted but is frequently unsuccessful.
  
  
  
  This trial does not appear on a registry as it is neither randomized nor prospective.
authors.affiliation: Malcom Randall VAMC, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Box 111-D, Gainesville, FL USA.|Division of Cardiovascular Medicine, University of Florida College of Medicine, Malcom Randall VAMC, 1601 SW Archer Rd, Box 111-D, Gainesville, FL USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Winchester
authors.affiliation: Department of Medicine, University of Florida College of Medicine, Gainesville, FL USA.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Bolanos
authors.affiliation: Malcom Randall VAMC, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Box 111-D, Gainesville, FL USA.|Division of Cardiovascular Medicine, University of Florida College of Medicine, Malcom Randall VAMC, 1601 SW Archer Rd, Box 111-D, Gainesville, FL USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Wokhlu
authors.affiliation: Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, FL USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Beyth
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000009:adverse effects* / Q000379:methods; D009204:Myocardial Revascularization / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data
keywords: Myocardial ischemia; Nuclear myocardial perfusion imaging; Revascularization; Veterans