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Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction.

Publication ,  Journal Article
Farzaneh-Far, A; Phillips, HR; Shaw, LK; Starr, AZ; Fiuzat, M; O'Connor, CM; Sastry, A; Shaw, LJ; Borges-Neto, S
Published in: JACC Cardiovasc Imaging
July 2012

OBJECTIVES: The aim of this study was to evaluate the independent prognostic significance of ischemia change in stable coronary artery disease (CAD). BACKGROUND: Recent randomized trials in stable CAD have suggested that revascularization does not improve outcomes compared with optimal medical therapy (MT). In contrast, the nuclear substudy of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial found that revascularization led to greater ischemia reduction and suggested that this may be associated with improved unadjusted outcomes. Thus, the effects of MT versus revascularization on ischemia change and its independent prognostic significance requires further investigation. METHODS: From the Duke Cardiovascular Disease and Nuclear Cardiology Databanks, 1,425 consecutive patients with angiographically documented CAD who underwent 2 serial myocardial perfusion single-photon emission computed tomography scans were identified. Ischemia change was calculated for patients undergoing MT alone, percutaneous coronary intervention, or coronary artery bypass grafting. Patients were followed for a median of 5.8 years after the second myocardial perfusion scan. Cox proportional hazards regression modeling was used to identify factors independently associated with the primary outcome of death or myocardial infarction (MI). Formal risk reclassification analyses were conducted to assess whether the addition of ischemia change to traditional predictors resulted in improved risk classification for death or MI. RESULTS: More MT patients (15.6%) developed ≥5% ischemia worsening compared with those undergoing percutaneous coronary intervention (6.2%) or coronary artery bypass grafting (6.7%) (p < 0.001). After adjustment for established predictors, ≥5% ischemia worsening remained a significant independent predictor of death or MI (hazard ratio: 1.634; p = 0.0019) irrespective of treatment arm. Inclusion of ≥5% ischemia worsening in this model resulted in significant improvement in risk classification (net reclassification improvement: 4.6%, p = 0.0056) and model discrimination (integrated discrimination improvement: 0.0062, p = 0.0057). CONCLUSIONS: In stable CAD, ischemia worsening is an independent predictor of death or MI, resulting in significantly improved risk reclassification when added to previously known predictors.

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

July 2012

Volume

5

Issue

7

Start / End Page

715 / 724

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, Emission-Computed, Single-Photon
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Proportional Hazards Models
  • Predictive Value of Tests
  • Percutaneous Coronary Intervention
  • North Carolina
 

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Farzaneh-Far, A., Phillips, H. R., Shaw, L. K., Starr, A. Z., Fiuzat, M., O’Connor, C. M., … Borges-Neto, S. (2012). Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction. JACC Cardiovasc Imaging, 5(7), 715–724. https://doi.org/10.1016/j.jcmg.2012.01.019
Farzaneh-Far, Afshin, Harry R. Phillips, Linda K. Shaw, Aijing Z. Starr, Mona Fiuzat, Christopher M. O’Connor, Ashwani Sastry, Leslee J. Shaw, and Salvador Borges-Neto. “Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction.JACC Cardiovasc Imaging 5, no. 7 (July 2012): 715–24. https://doi.org/10.1016/j.jcmg.2012.01.019.
Farzaneh-Far A, Phillips HR, Shaw LK, Starr AZ, Fiuzat M, O’Connor CM, et al. Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction. JACC Cardiovasc Imaging. 2012 Jul;5(7):715–24.
Farzaneh-Far, Afshin, et al. “Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction.JACC Cardiovasc Imaging, vol. 5, no. 7, July 2012, pp. 715–24. Pubmed, doi:10.1016/j.jcmg.2012.01.019.
Farzaneh-Far A, Phillips HR, Shaw LK, Starr AZ, Fiuzat M, O’Connor CM, Sastry A, Shaw LJ, Borges-Neto S. Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction. JACC Cardiovasc Imaging. 2012 Jul;5(7):715–724.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

July 2012

Volume

5

Issue

7

Start / End Page

715 / 724

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, Emission-Computed, Single-Photon
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Proportional Hazards Models
  • Predictive Value of Tests
  • Percutaneous Coronary Intervention
  • North Carolina