Myocardial ischemia on stress testing shows no CV event association

  • Garzillo CL & al.
  • JAMA Intern Med
  • 22 jul. 2019

  • de Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Myocardial ischemia on stress testing shows no association with a composite of cardiovascular (CV) events or with ventricular function among patients with stable multivessel coronary artery disease (CAD).

Why this matters

  • Some findings had suggested an association between myocardial ischemia on stress testing and later events in these patients, which has been used to guide revascularization decisions.
  • More recent data suggested no role at least for moderate ischemia in treatment outcomes.

Key results

  • Compared with no baseline ischemia, ischemia at baseline was not linked to event-free survival:
    • aHR, 1.00 (95% CI, 0.80-1.27).
  • Ventricular functional decline was similar with or without baseline ischemia (P=.97).
  • Outcomes did not change with therapy type (percutaneous coronary intervention, coronary artery bypass grafting [CABG], optimal medical treatment).
  • CABG was linked to higher event-free survival vs the other two.

Study design

  • Analysis of single-center cohort data from a randomized clinical trial.
  • 535 patients were randomly allocated to 1 of the 3 therapies.
  • Outcome: composite of overall mortality, myocardial infarction, revascularization for refractory angina.
  • Minimum follow-up for surviving participants was 10 years; maximum was 15 years.
  • Funding: Zerbini Foundation.

Limitations

  • Retrospective analysis.
  • Medical therapy changed during the follow-up.
  • Single center.