Optimal Medical Therapy With or Without Percutaneous Coronary Intervention to Reduce Ischemic Burden

Shaw, Leslee J.; Berman, Daniel S.; Maron, David J.; Mancini, G.B. John; Hayes, Sean W.; Hartigan, Pamela; Weintraub, William S.; O’Rourke, Robert A.; Dada, Marcin; Spertus, John A.; Chaitman, Bernard R.; Friedman, John D.; Slomka, Piotr J.; Heller, Gary V.; Germano, Guido; Gosselin, Gilbert; Berger, Peter B.; Kostuk, William J.; Schwartz, Ronald G.; Knudtson, Merill L; Veledar, Emir; Bates, Eric R.; McCallister, Benjamin D.; Teo, Koon; Boden, William E.

doi:10.1161/circulationaha.107.743963

Cited by 1,468 publications

(417 citation statements)

References 19 publications

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“…24 Nonetheless, among the subgroup of COURAGE patients evaluated with stress MPS, patients who proceeded to cardiac catheterization and angioplasty demonstrated a reduced ischemic burden. 25 Furthermore, a subsequent quality of life analysis among COURAGE participants demonstrated a small, but significant early improvement in quality of life among symptomatic patients who proceeded to cardiac catheterization and angioplasty. 26 Although mildly abnormal test results may not proceed to further testing in all patients, our analysis required a standard dichotomous decision model to compute diagnostic accuracy, expected radiation exposure and costs.…”

Section: Discussionmentioning

confidence: 99%

Decision Analytic Model for Evaluation of Suspected Coronary Disease with Stress Testing and Coronary CT Angiography

Halpern¹,

Fischman²,

Savage³

et al. 2010

Academic Radiology

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Section: Discussionmentioning

confidence: 99%

Decision Analytic Model for Evaluation of Suspected Coronary Disease with Stress Testing and Coronary CT Angiography

Halpern¹,

Fischman²,

Savage³

et al. 2010

Academic Radiology

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“…In the treatment of patients with CAD, PCI has been an important option to relieve angina and reduce the extent of myocardial ischemia 14. Along with selection of the appropriate candidate, determining the extent of revascularization has been a major concern when performing PCI.…”

Section: Discussionmentioning

confidence: 99%

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Kim

Lee

Choi

et al. 2018

JAHA

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BackgroundThere are limited data regarding the prognostic impact of angiographic complete revascularization (CR) in patients with chronic kidney disease (CKD). We sought to investigate the differential prognostic impact of angiographic CR over incomplete revascularization (IR), according to the presence of CKD in the drug‐eluting stent era.Methods and ResultsBetween 2003 and 2011 at Samsung Medical Center, consecutive patients with multivessel disease were stratified by the presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2) and classified according to angiographic CR (residual SYNTAX score=0) or IR. Clinical outcomes were compared between angiographic CR and IR, stratified by the presence of CKD. Primary outcome was patient‐oriented composite outcomes (POCO, a composite of all‐cause death, myocardial infarction, any revascularization) at 3 years. Inverse probability weighting was performed between the CR and IR groups. A total of 3224 patients were eligible for analysis: 2295 without CKD; 929 with CKD. Among non‐CKD patients, angiographic CR showed a significantly lower risk of POCO than IR (17.2% versus 21.7%, adjusted hazard ratio 0.76, 95% confidence interval, 0.62–0.95, P=0.014), mainly driven by a significantly lower risk of any revascularization. Among CKD patients, however, angiographic CR was associated with a significantly higher risk of POCO than IR (37.7% versus 28.4%, adjusted hazard ratio 1.42, 95% confidence interval, 1.08%–1.85%, P=0.011), mainly driven by a significantly higher risk of nonfatal target vessel myocardial infarction.ConclusionsAngiographic CR was associated with reduced risk of POCO than IR in patients without CKD; however, it was associated with a significantly higher risk of POCO and nonfatal myocardial infarction in CKD patients.

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“…The presence of ischemia is a prerequisite for the improvement of clinical outcomes utilizing percutaneous coronary intervention 1. It is well known that a discrepancy exists between angiographic stenosis severity and the presence of myocardial ischemia 2, 3, 4, 5, 6, 7, 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Deferred Lesions With Angiographically Insignificant Stenosis But Low Fractional Flow Reserve

Lee

Koo

Shin

et al. 2017

JAHA

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BackgroundData are limited regarding outcomes of deferred lesions in patients with angiographically insignificant stenosis but low fractional flow reserve (FFR). We investigated the natural history of angiographically insignificant stenosis with low FFR among patients who underwent routine 3‐vessel FFR measurement.Methods and ResultsFrom December 2011 to March 2014, 1136 patients with 3298 vessels underwent routine 3‐vessel FFR measurement (3V FFR‐FRIENDS study, ClinicalTrials.gov identifier NCT01621438), and this study analyzed the 2‐year clinical outcomes of 1024 patients with 2124 lesions with angiographically insignificant stenosis (percentage of diameter stenosis <50%), in which revascularization was deferred. All lesions were classified according to FFR values, using a cutoff of 0.80 (high FFR >0.80 versus low FFR ≤0.80). The primary end point was outcome of major adverse cardiovascular events (a composite of cardiac death, myocardial infarction, and ischemia‐driven revascularization) at 2 years. Mean angiographic percentage of diameter stenosis and FFR of total lesions were 32.5±10.3% and 0.91±0.08%, respectively. Among the total lesions with angiographically insignificant stenosis, 8.7% showed low FFR (185 lesions). The incidence of lesions with low FFR was 2.5%, 3.8%, 9.0%, and 15.1% in categories of percentage of diameter stenosis <20%, 20% to 30%, 30% to 40%, and 40% to 50%, respectively. At 2‐year follow‐up, the low‐FFR group showed a significantly higher risk of major adverse cardiovascular events compared with the high FFR group (3.3% versus 1.2%, hazard ratio: 3.371; 95% CI, 1.346–8.442; P=0.009). In multivariable analysis, low FFR was the most powerful independent predictor of future MACE in deferred lesions with angiographically insignificant stenosis (adjusted hazard ratio: 2.617; 95% CI, 1.026–6.679; P=0.044).ConclusionsIn deferred angiographically insignificant stenosis, lesions with low FFR showed significantly higher event rates than those with high FFR. FFR was an independent predictor of future major adverse cardiovascular events in lesions with angiographically insignificant stenosis.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01621438.

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Optimal Medical Therapy With or Without Percutaneous Coronary Intervention to Reduce Ischemic Burden

Abstract: In COURAGE patients who underwent serial MPS, adding PCI to OMT resulted in greater reduction in ischemia compared with OMT alone. Our findings suggest a treatment target of > or = 5% ischemia reduction with OMT with or without coronary revascularization.

Cited by 1,468 publications

References 19 publications

Decision Analytic Model for Evaluation of Suspected Coronary Disease with Stress Testing and Coronary CT Angiography

Decision Analytic Model for Evaluation of Suspected Coronary Disease with Stress Testing and Coronary CT Angiography

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Clinical Outcomes of Deferred Lesions With Angiographically Insignificant Stenosis But Low Fractional Flow Reserve

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