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

Int J Cardiol. 2019 Feb 15:277:47-53. doi: 10.1016/j.ijcard.2018.08.006. Epub 2018 Aug 3.

Abstract

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.

Keywords: Coronary artery bypass graft surgery; Coronary artery disease; Outcomes; Percutaneous coronary intervention; Silent myocardial ischemia.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Asymptomatic Diseases / mortality
  • Asymptomatic Diseases / therapy*
  • Coronary Artery Bypass / mortality
  • Coronary Artery Bypass / trends
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends
  • Myocardial Ischemia / diagnostic imaging*
  • Myocardial Ischemia / mortality
  • Myocardial Ischemia / therapy*
  • Myocardial Revascularization / mortality
  • Myocardial Revascularization / trends*
  • Percutaneous Coronary Intervention / mortality
  • Percutaneous Coronary Intervention / trends
  • Platelet Aggregation Inhibitors / administration & dosage
  • Prospective Studies
  • Registries
  • Tomography, Emission-Computed, Single-Photon / mortality
  • Tomography, Emission-Computed, Single-Photon / trends
  • Treatment Outcome

Substances

  • Platelet Aggregation Inhibitors