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Benefit of Early Myocardial Revascularization Explored

No mortality benefit seen with revascularization in patients with reduced LVEF and no or mild myocardial ischemia

WEDNESDAY, Aug. 3, 2022 (HealthDay News) — The benefits of early myocardial revascularization vary with left ventricular ejection fraction (LVEF) and myocardial injury, according to a study published online in the July 19 issue of the Journal of the American College of Cardiology.

Alan Rozanski, M.D., from Mount Sinai Morningside Hospital in New York City, and colleagues evaluated 43,443 patients undergoing stress-rest single-photon emission computed tomography myocardial perfusion imaging between 1998 and 2017, with median follow-up of 11.4 years. The association of stress-induced myocardial ischemia and revascularization with all-cause mortality was examined among those with normal versus low LVEF.

The researchers found marked variation in the frequency of myocardial ischemia according to LVEF and angina, from 6.7 to 64.0 percent among patients with LVEF ≥55 percent and no typical angina and among those with LVEF <45 percent and typical angina, respectively. Among 39,883 patients with LVEF ≥45 percent, early revascularization was associated with increased mortality risk and lower mortality risk among those without ischemia and with severe ischemia, respectively. Among 3,560 patients with LVEF <45 percent, for those with no or mild ischemia, no association was seen for revascularization with mortality benefit, while revascularization was associated with reduced mortality among those with moderate and severe ischemia.

“Our findings underscore the general lack of benefit to performing myocardial revascularization procedures among stable patients who do not manifest inducible myocardial ischemia, even when LVEF is reduced,” the authors write.

One author disclosed receiving royalties for QPS software.

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