The Relationship Between Quantitative Ischemia, Early Revascularization, and Major Adverse Cardiovascular Events

Robert JH. Miller, MD; Bryan Bednarski, MSc; Yujie Cui, MSc; Vinicius Calsavara, PhD; Krishna Patel, MD; Alan Rozanski, MD; Joanna X. Liang, MPH; Valerie Builoff, BSc; Wanda Acampa, MD; Timothy M. Bateman, MD; Marcelo Di Carli, MD; Sharmila Dorbala, MD, MPH; Andrew J. Einstein, MD, PhD; Matthews B. Fish, MD; M. Timothy Hauser, MD; Philipp A. Kaufmann, MD; Edward J. Miller, MD, PhD; Terrence D. Ruddy, MD; Tali Sharir, MD; Albert J. Sinusas, MD; Damini Dey, PhD; Daniel S. Berman, MD; Piotr J. Slomka, PhD

JACC: Advances (Jan 2025)

The Relationship Between Quantitative Ischemia, Early Revascularization, and Major Adverse Cardiovascular Events

Robert JH. Miller, MD,
Bryan Bednarski, MSc,
Yujie Cui, MSc,
Vinicius Calsavara, PhD,
Krishna Patel, MD,
Alan Rozanski, MD,
Joanna X. Liang, MPH,
Valerie Builoff, BSc,
Wanda Acampa, MD,
Timothy M. Bateman, MD,
Marcelo Di Carli, MD,
Sharmila Dorbala, MD, MPH,
Andrew J. Einstein, MD, PhD,
Matthews B. Fish, MD,
M. Timothy Hauser, MD,
Philipp A. Kaufmann, MD,
Edward J. Miller, MD, PhD,
Terrence D. Ruddy, MD,
Tali Sharir, MD,
Albert J. Sinusas, MD,
Damini Dey, PhD,
Daniel S. Berman, MD,
Piotr J. Slomka, PhD

Affiliations

Robert JH. Miller, MD: Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
Bryan Bednarski, MSc: Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States
Yujie Cui, MSc: Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States; Department of Biostatistics and Bioinformatic Research Center, Cedars-Sinai Medical Center, Los Angeles, California, United States
Vinicius Calsavara, PhD: Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States; Division of Cardiology and Department of Medicine, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, New York, USA
Krishna Patel, MD: Division of Cardiology and Department of Medicine, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, New York, USA
Alan Rozanski, MD: Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States; Division of Cardiology and Department of Medicine, Mount Sinai Heart and the Icahn School of Medicine at Mount Sinai, New York, New York, USA
Joanna X. Liang, MPH: Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States
Valerie Builoff, BSc: Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States
Wanda Acampa, MD: Department of Advanced Biomedical Sciences, University of Naples ''Federico II'', Naples, Italy
Timothy M. Bateman, MD: Cardiovascular Imaging Technologies, LLC, Kansas City, Missouri, United States
Marcelo Di Carli, MD: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
Sharmila Dorbala, MD, MPH: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
Andrew J. Einstein, MD, PhD: Division of Cardiology, Department of Medicine, and Radiology, Columbia University Irving Medical Center, New York, New York, United States
Matthews B. Fish, MD: Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, Oregon, United States
M. Timothy Hauser, MD: Department of Nuclear Cardiology, Oklahoma Heart Hospital, Oklahoma City, Oklahoma, United States
Philipp A. Kaufmann, MD: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
Edward J. Miller, MD, PhD: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut, United States
Terrence D. Ruddy, MD: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Tali Sharir, MD: Department of Nuclear Cardiology, Assuta Medical Center, Tel Aviv, Israel
Albert J. Sinusas, MD: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut, United States
Damini Dey, PhD: Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States
Daniel S. Berman, MD: Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States
Piotr J. Slomka, PhD: Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, California, United States; Address for correspondence: Dr Piotr Slomka, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, California 90048, USA.

Journal volume & issue: Vol. 4, no. 1
p. 101440

Abstract

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Background: Observational data have suggested that patients with moderate to severe ischemia benefit from revascularization. However, this was not confirmed in a large, randomized trial. Objectives: Using a contemporary, multicenter registry, the authors evaluated differences in the association between quantitative ischemia, revascularization, and outcomes across important subgroups. Methods: Patients who underwent myocardial perfusion imaging in 12 centers were included in this retrospective analysis. The population was divided into original (2009-2014) and recent (2014-2021) registry sites. Early revascularization was defined as any revascularization within 90 days of myocardial perfusion imaging. A propensity score was developed to adjust for nonrandomization. Propensity score-adjusted survival analyses were used to evaluate the associations between quantitative ischemia, early revascularization, and death or myocardial infarction (MI) to identify at what severity of ischemia the HR for early revascularization crosses 1 (threshold for potential benefit). Results: Overall, 40,449 patients were included with a median follow-up of 3.5 (IQR: 2.4-4.6) years, during which death or MI occurred in 2,797 (6.9%). Early revascularization was associated with reduced death or MI in patients with >9.0% myocardial ischemia (95% upper CI: 11.2%, interaction P 10.0%) and male patients (>8.6%). Conclusions: Early revascularization was associated with reduced risk in patients with a higher burden of quantitative ischemia in more recent populations. These findings suggest that methods integrating more factors than just ischemia are needed to improve patient selection for revascularization.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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