Impact of Early Revascularization on Major Adverse Cardiovascular Events in Relation to Automatically Quantified Ischemia

Peyman N Azadani; Robert J H Miller; Tali Sharir; Marcio A Diniz; Lien-Hsin Hu; Yuka Otaki; Heidi Gransar; Joanna X Liang; Evann Eisenberg; Andrew J Einstein; Mathews B Fish; Terrence D Ruddy; Philipp A Kaufmann; Albert J Sinusas; Edward J Miller; Timothy M Bateman; Sharmila Dorbala; Marcelo Di Carli; Balaji K Tamarappoo; Damini Dey; Daniel S Berman; Piotr J Slomka

doi:10.1016/j.jcmg.2020.05.039

Impact of Early Revascularization on Major Adverse Cardiovascular Events in Relation to Automatically Quantified Ischemia

JACC Cardiovasc Imaging. 2021 Mar;14(3):644-653. doi: 10.1016/j.jcmg.2020.05.039. Epub 2020 Aug 19.

Authors

Peyman N Azadani¹, Robert J H Miller², Tali Sharir³, Marcio A Diniz⁴, Lien-Hsin Hu⁵, Yuka Otaki⁶, Heidi Gransar⁶, Joanna X Liang⁶, Evann Eisenberg⁶, Andrew J Einstein⁷, Mathews B Fish⁸, Terrence D Ruddy⁹, Philipp A Kaufmann¹⁰, Albert J Sinusas¹¹, Edward J Miller¹¹, Timothy M Bateman¹², Sharmila Dorbala¹³, Marcelo Di Carli¹³, Balaji K Tamarappoo⁶, Damini Dey⁶, Daniel S Berman⁶, Piotr J Slomka¹⁴

Affiliations

¹ Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
² Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
³ Department of Nuclear Cardiology, Assuta Medical Center, Tel Aviv, Israel.
⁴ Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; Biostatistics and Bioinformatic Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁵ Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶ Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁷ Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA.
⁸ Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, Oregon, USA.
⁹ Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
¹⁰ Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
¹¹ Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut, USA.
¹² Cardiovascular Imaging Technologies LLC, Kansas City, Missouri, USA.
¹³ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁴ Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA. Electronic address: slomkap@cshs.org.

Abstract

Objectives: Using a contemporary, multicenter international single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) registry, this study characterized the potential major adverse cardiovascular event(s) (MACE) benefit of early revascularization based on automatic quantification of ischemia.

Background: Prior single-center data reported an association between moderate to severe ischemia SPECT-MPI and reduced cardiac death with early revascularization.

Methods: Consecutive patients from a multicenter, international registry who underwent ^99mTc SPECT-MPI between 2009 and 2014 with solid-state scanners were included. Ischemia was quantified automatically as ischemic total perfusion deficit (TPD). Early revascularization was defined as within 90 days. The primary outcome was MACE (death, myocardial infarction, and unstable angina). A propensity score was developed to adjust for nonrandomization of revascularization; then, multivariable Cox modeling adjusted for propensity score and demographics was used to predict MACE.

Results: In total, 19,088 patients were included, with a mean follow-up of 4.7 ± 1.6 years, during which MACE occurred in 1,836 (9.6%) patients. There was a significant interaction between ischemic TPD modeled as a continuous variable and early revascularization (interaction p value: 0.012). In this model, there was a trend toward reduced MACE in patients with >5.4% ischemic TPD and a significant association with reduced MACE in patients with >10.2% ischemic TPD.

Conclusions: In this large, international, multicenter study reflecting contemporary cardiology practice, early revascularization of patients with >10.2% ischemia on SPECT-MPI, quantified automatically, was associated with reduced MACE.

Keywords: MACE; ischemia; revascularization.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Ischemia
Myocardial Ischemia* / diagnostic imaging
Myocardial Perfusion Imaging*
Predictive Value of Tests
Tomography, Emission-Computed, Single-Photon

Abstract

Publication types

MeSH terms

Grants and funding