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首页> 外文期刊>JACC. Cardiovascular imaging. >Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction
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Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction

机译：稳定冠状动脉疾病的缺血性变化是死亡和心肌梗死的独立预测因子

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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.
机译：目的：本研究旨在评估缺血性改变对稳定冠心病（CAD）的独立预后意义。背景：最近在稳定的CAD中进行的随机试验表明，与最佳药物治疗（MT）相比，血运重建并不能改善结局。相比之下，COURAGE（利用血运重建和积极药物评估的临床结果）试验的核子研究发现，血运重建可导致更大程度的缺血减少，并暗示这可能与未经调整的预后改善有关。因此，MT与血运重建对缺血变化的影响及其独立的预后意义需要进一步研究。方法：从Duke心血管疾病和核心脏病学数据库中，鉴定出1,425例接受2次连续心肌灌注单光子发射计算机断层扫描的血管造影记录的CAD患者。计算仅接受MT，经皮冠状动脉介入治疗或冠状动脉搭桥术的患者的缺血性变化。第二次心肌灌注扫描后随访患者中位时间为5.8年。使用Cox比例风险回归模型确定与死亡或心肌梗塞（MI）的主要结局独立相关的因素。进行了正式的风险重新分类分析，以评估是否将缺血变化添加到传统预测因素中导致死亡或心梗的风险分类得到改善。结果：与接受经皮冠状动脉介入治疗（6.2％）或冠状动脉搭桥术（6.7％）的患者相比，更多的MT患者（15.6％）发生了<5％的缺血恶化（p <0.001）。调整既定的预测因素后，与治疗组无关，＜5％缺血恶化仍是死亡或心梗的重要独立预测因素（危险比：1.634; p = 0.0019）。在该模型中纳入<5％的缺血性恶化，可显着改善风险分类（净重分类改善：4.6％，p = 0.0056）和模型判别（综合辨别力改善：0.0062，p = 0.0057）。结论：在稳定的CAD中，缺血恶化是死亡或MI的独立预测因子，当添加到先前已知的预测因子中时，可显着改善风险重新分类。

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