Clinical InvestigationsCardiovascular events in patients with coronary artery disease with and without myocardial ischemia: Long-term follow-up
Section snippets
Study design
This was a single-center, retrospective, observational cohort study that included patients with CAD extracted from the research protocols database of “The Medicine, Angioplasty or Surgery Study,” the “MASS Study Group,” from the Heart Institute of University of São Paulo- (InCor-HCFMUSP)
Patient selection
Patients included in the present study are part of the MASS Research Group. This database was created to include patients with myocardial ischemia and CAD confirmed by angiographic studies. Thus, patients with
Definition
Diagnosis of CAD was confirmed by angiographic examination with presentation of luminal stenosis >70% in the main coronary arteries or their major branches. Myocardial ischemia was identified by the presence of angina pectoris and confirmed by functional testing with or without imaging. Left ventricular function estimated by LV ejection fraction ≥50% was considered preserved.
Objective evidence of myocardial ischemia was defined as a new resting ST-segment and T-wave alteration or the emergence
Baseline clinical characteristics
In the period between 1995 and 2018, 1915 patients with chronic CAD in follow-up were available in the MASS registry database. Of this sample, 1188 had undergone an ischemic test at entry into the registry, and of these, 1001 had an ischemic test with conclusive results. Of these, 790 patients had positive tests for ischemia and 211 had negative tests for ischemia. The median follow-up for this population was 8.7 years (IQR: 4.04-10.07), with no loss to follow-up (Figure 1).
The baseline
Discussion
In this sample, the presence of myocardial ischemia was not related to an increase in cardiovascular outcomes, death, or AMI in the long-term follow-up. The ischemic burden was also not related to the increase in cardiovascular outcomes. Moreover, myocardial ischemia was not an independent predictor for combined events or death in this sample. The interpretation of this result must be made considering the population studied. In this sample, we observed more than 70% with 3-vessel disease,
Conclusions
In our sample, the presence of myocardial ischemia was not associated with a higher event rate in patients with multivessel CAD, regardless of the initial treatment used.
Author Contributions
FPCC: carried out conception and design, acquisition of data, analysis and interpretation of data, was involved in drafting the manuscript and revising it critically for important intellectual content, has given final approval of the version to be published.
WH: carried out conception and design, acquisition of data, analysis and interpretation of data, was involved in drafting the manuscript and revising it critically for important intellectual content, has given final approval of the version
Funding
Financial support for the present study was provided in part by a research grant from Zerbini Foundation.
Disclosures
None reported.
Acknowledgments
Support for the present study was provided in part by the Zerbini Foundation, São Paulo, Brazil, and Ann Conti Morcos of MorcosMedia provided medical writing support during the preparation of this paper. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents.
References (24)
- et al.
Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography
J Am Coll Cardiol
(1995) - et al.
Prognostic value of gated myocardial perfusion SPECT
J Nucl Cardiol
(2004) - et al.
Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention
Am Heart J
(2012) - et al.
Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial
J Nucl Cardiol
(2012) - et al.
Predicting outcome in the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation): coronary anatomy versus ischemia
J Am Coll Cardiol Intv
(2014) - et al.
Single photon-emission computed tomography
J Nucl Cardiol
(2010) - et al.
American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography
J Am Soc Echocardiogr
(2007) - et al.
Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient's sex
JACC Cardiovasc Imaging
(2011) - et al.
A prognostic score for prediction of cardiac mortality risk after adenosine stress myocardial perfusion scintigraphy
J Am Coll Cardiol
(2005) - et al.
Impact of plaque burden versus stenosis on ischemic events in patients with coronary atherosclerosis
J Am Coll Cardiol
(2020)