Extent of Myocardial Ischemia on Positron Emission Tomography and Survival Benefit with Early Revascularization

作者：K. Patel, John A. Spertus, Paul S. Chan, B. Sperry, Randall C. Thompson, F. A. Al Badarin, Kevin F. Kennedy, J. Case, Staci A. Courter, Ibrahim M. Saeed, A. Iain McGhie, Timothy M. Bateman · 发表于：Journal of the American College of Cardiology · 年份：2019 · DOI：10.1016/j.jacc.2019.07.055 · 被引用次数：98 · 研究领域：Medicine

Background: Prior studies with single photon emission computed tomography myocardial perfusion imaging (SPECT) MPI have shown a survival benefit with early revascularization in patients with >10-12.5% ischemic myocardium. The relationship between positron emission tomography (PET) -derived degree of ischemia, early revascularization, and survival is unknown. Objectives: To evaluate the association between percent ischemia on PET MPI, revascularization, and survival. Methods: We followed 16,029 unique consecutive patients undergoing Rubidium-82 rest-stress PET MPI from 2010-2016. Patients with known cardiomyopathy and non-diagnostic perfusion results were excluded. Percent ischemic myocardium was estimated from a 17-segment model. Propensity scoring was used to account for non-randomized referral to early revascularization (90 days of PET). A Cox model was developed, adjusting for propensity scores for early revascularization and %ischemia, and an interaction between ischemia and early revascularization was tested. Results: Median follow-up was 3.7 years. Overall, 1277 (8%) patients underwent early revascularization and 2,493 (15.6%) died (738 cardiac). Nearly 37% of patients (n = 5,902) had ischemia, with 13.5% (n = 2,160) having ≥ 10%. In propensity-adjusted analyses, there was a significant interaction between ischemia and early revascularization (p <0.001 for all cause and cardiac death), such that patients with greater ischemia had improved survival with early revasculari...