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Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial.

Publication ,  Journal Article
Senior, R; Reynolds, HR; Min, JK; Berman, DS; Picard, MH; Chaitman, BR; Shaw, LJ; Page, CB; Govindan, SC; Lopez-Sendon, J; Peteiro, J ...
Published in: J Am Coll Cardiol
February 22, 2022

BACKGROUND: Detection of ≥50% diameter stenosis left main coronary artery disease (LMD) has prognostic and therapeutic implications. Noninvasive stress imaging or an exercise tolerance test (ETT) are the most common methods to detect obstructive coronary artery disease, though stress test markers of LMD remain ill-defined. OBJECTIVES: The authors sought to identify markers of LMD as detected on coronary computed tomography angiography (CTA), using clinical and stress testing parameters. METHODS: This was a post hoc analysis of ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), including randomized and nonrandomized participants who had locally determined moderate or severe ischemia on nonimaging ETT, stress nuclear myocardial perfusion imaging, or stress echocardiography followed by CTA to exclude LMD. Stress tests were read by core laboratories. Prior coronary artery bypass grafting was an exclusion. In a stepped multivariate model, the authors identified predictors of LMD, first without and then with stress testing parameters. RESULTS: Among 5,146 participants (mean age 63 years, 74% male), 414 (8%) had LMD. Predictors of LMD were older age (P < 0.001), male sex (P < 0.01), absence of prior myocardial infarction (P < 0.009), transient ischemic dilation of the left ventricle on stress echocardiography (P = 0.05), magnitude of ST-segment depression on ETT (P = 0.004), and peak metabolic equivalents achieved on ETT (P = 0.001). The models were weakly predictive of LMD (C-index 0.643 and 0.684). CONCLUSIONS: In patients with moderate or severe ischemia, clinical and stress testing parameters were weakly predictive of LMD on CTA. For most patients with moderate or severe ischemia, anatomical imaging is needed to rule out LMD. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

February 22, 2022

Volume

79

Issue

7

Start / End Page

651 / 661

Location

United States

Related Subject Headings

  • Single Photon Emission Computed Tomography Computed Tomography
  • Predictive Value of Tests
  • Positron-Emission Tomography
  • Myocardial Perfusion Imaging
  • Middle Aged
  • Male
  • Internationality
  • Humans
  • Female
  • Coronary Vessels
 

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Senior, R., Reynolds, H. R., Min, J. K., Berman, D. S., Picard, M. H., Chaitman, B. R., … ISCHEMIA Research Group, . (2022). Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial. J Am Coll Cardiol, 79(7), 651–661. https://doi.org/10.1016/j.jacc.2021.11.052
Senior, Roxy, Harmony R. Reynolds, James K. Min, Daniel S. Berman, Michael H. Picard, Bernard R. Chaitman, Leslee J. Shaw, et al. “Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial.J Am Coll Cardiol 79, no. 7 (February 22, 2022): 651–61. https://doi.org/10.1016/j.jacc.2021.11.052.
Senior R, Reynolds HR, Min JK, Berman DS, Picard MH, Chaitman BR, et al. Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial. J Am Coll Cardiol. 2022 Feb 22;79(7):651–61.
Senior, Roxy, et al. “Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial.J Am Coll Cardiol, vol. 79, no. 7, Feb. 2022, pp. 651–61. Pubmed, doi:10.1016/j.jacc.2021.11.052.
Senior R, Reynolds HR, Min JK, Berman DS, Picard MH, Chaitman BR, Shaw LJ, Page CB, Govindan SC, Lopez-Sendon J, Peteiro J, Wander GS, Drozdz J, Marin-Neto J, Selvanayagam JB, Newman JD, Thuaire C, Christopher J, Jang JJ, Kwong RY, Bangalore S, Stone GW, O’Brien SM, Boden WE, Maron DJ, Hochman JS, ISCHEMIA Research Group. Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial. J Am Coll Cardiol. 2022 Feb 22;79(7):651–661.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

February 22, 2022

Volume

79

Issue

7

Start / End Page

651 / 661

Location

United States

Related Subject Headings

  • Single Photon Emission Computed Tomography Computed Tomography
  • Predictive Value of Tests
  • Positron-Emission Tomography
  • Myocardial Perfusion Imaging
  • Middle Aged
  • Male
  • Internationality
  • Humans
  • Female
  • Coronary Vessels