Comparison of long-term clinical outcomes between revascularization versus medical treatment in patients with silent myocardial ischemia

被引：7

作者：

Choi, Ki Hong ^{[1
]}

Lee, Joo Myung ^{[1
]}

Park, Il ^{[1
]}

Kim, Jihoon ^{[1
]}

Rhee, Tae-Min ^{[2
]}

Hwang, Doyeon ^{[3
,4
]}

Park, Jonghanne ^{[5
]}

Park, Taek Kyu ^{[1
]}

Yang, Jeong Hoon ^{[1
]}

Bin Song, Young ^{[1
]}

Hahn, Joo-Yong ^{[1
]}

Jeong, Dong Seop ^{[6
]}

Cho, Yang Hyun ^{[6
]}

Kim, Wook Sung ^{[6
]}

Sung, Kiick ^{[6
]}

Jang, Mi Ja ^{[7
]}

Sung, Ji Dong ^{[7
]}

Choi, Jin-Ho ^{[1
]}

Choi, Seung-Hyuk ^{[1
]}

Koo, Bon-Kwon ^{[3
,4
]}

Lee, Young Tak ^{[6
]}

Kim, Eun Kyoung ^{[8
]}

Chang, Sung A. ^{[8
]}

Park, Sung-Ji ^{[8
]}

Choi, Jin-Oh ^{[8
]}

Lee, Sang-Chol ^{[8
]}

Park, Seung Woo ^{[8
]}

Cho, Young Seok ^{[9
]}

Choi, Joon Young ^{[9
]}

Gwon, Hyeon-Cheol ^{[1
]}

Oh, Jae K. ^{[8
,10
]}

机构：

[1] Sungkyunkwan Univ, Heart Vasc Stroke Inst, Dept Internal Med, Div Cardiol,Sch Med,Samsung Med Ctr, Seoul, South Korea

[2] Natl Maritime Med Ctr, Chang Won, South Korea

[3] Seoul Natl Univ Hosp, Dept Internal Med, Seoul, South Korea

[4] Seoul Natl Univ Hosp, Cardiovasc Ctr, Seoul, South Korea

[5] Minist Hlth & Welf, Dept Internal Med, Naju Natl Hosp, Naju, South Korea

[6] Sungkyunkwan Univ, Samsung Med Ctr, Dept Thorac & Cardiovasc Surg, Heart Vasc Stroke Inst,Sch Med, Seoul, South Korea

[7] Sungkyunkwan Univ, Samsung Med Ctr, Heart Vasc Stroke Inst, Cardiac Rehabil & Prevent Ctr,Sch Med, Seoul, South Korea

[8] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Cardiovasc Imaging Ctr,Heart Vasc Stroke Inst, Seoul, South Korea

[9] Sungkyunkwan Univ, Samsung Med Ctr, Dept Nucl Med, Sch Med, Seoul, South Korea

[10] Mayo Clin, Coll Med, Div Cardiovasc Dis, Rochester, MN USA

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2019年 / 277卷

关键词：

Percutaneous coronary intervention; Coronary artery bypass graft surgery; Silent myocardial ischemia; Coronary artery disease; Outcomes; PERCUTANEOUS CORONARY INTERVENTION; FRACTIONAL FLOW RESERVE; INCREMENTAL PROGNOSTIC VALUE; ASSOCIATION TASK-FORCE; FOLLOW-UP; HEART-DISEASE; ARTERY-DISEASE; CARDIOVASCULAR ANGIOGRAPHY; PRACTICE GUIDELINES; AMERICAN-COLLEGE;

D O I：

10.1016/j.ijcard.2018.08.006

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: There have been limited and conflicting results regarding the prognostic impact of revascularization treatment on the long-term clinical outcomes of silent ischemia. The current study aimed to determine whether revascularization treatment compared with medical treatment (MT) alone reduces long-term risk of cardiac death of asymptomatic patients with objective evidence of inducible myocardial ischemia. METHODS: A total of 1473 consecutive asymptomatic patients with evidence of inducible myocardial ischemia were selected from a prospective institutional registry. All patients showed at least 1 epicardial coronary stenosis with >= 50% diameter stenosis in coronary angiography. Patients were classified according to their treatment strategies. The primary outcome was cardiac death up to 10?years. RESULTS: Among the total population, 709 patients (48.1%) received revascularization treatment including percutaneous coronary intervention (PCI, n?=?558) or coronary artery bypass graft surgery (CABG, n?=?151), with the remaining patients (764 patients, 51.9%) receiving MT alone. During the follow-up period, the revascularization treatment group showed a significantly lower risk of cardiac death compared with the MT alone group (25.4% vs. 33.7%, HR 0.624, 95%CI 0.498-0.781, p?<?0.001). Among revascularized patients, patients with negative non-invasive stress test results after revascularization showed significantly lower risk of cardiac death compared to those with residual myocardial ischemia (8.9% vs. 18.7%, HR 0.406, 95% CI 0.175-0.942, p?=?0.036). CONCLUSIONS: In patients with silent myocardial ischemia, revascularization treatment was associated with significantly lower long-term risk of cardiac death compared with the MT alone group. The current results support contemporary practice of ischemia-directed revascularization, even in patients with silent myocardial ischemia. Copyright (C) 2018 Elsevier B.V. All rights reserved.

引用

页码：47 / 53

页数：7