Temporal Trends in the Prevalence, Severity, and Localization of Myocardial Ischemia and Necrosis at Myocardial Perfusion Imaging After Myocardial Infarction
The definition, presentation, and management of myocardial infarction (MI) have changed substantially in the last decade. Whether these changes have impacted on the presence, severity, and localization of necrosis at myocardial perfusion imaging (MPI) has not been appraised to date. Subjects undergo...
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| Veröffentlicht in: | The American journal of cardiology 2017-10, Vol.120 (8), p.1238-1244 |
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| creator | Nudi, Francesco Schillaci, Orazio Di Belardino, Natale Versaci, Francesco Tomai, Fabrizio Pinto, Annamaria Neri, Giandomenico Procaccini, Enrica Nudi, Alessandro Frati, Giacomo Biondi-Zoccai, Giuseppe |
| description | The definition, presentation, and management of myocardial infarction (MI) have changed substantially in the last decade. Whether these changes have impacted on the presence, severity, and localization of necrosis at myocardial perfusion imaging (MPI) has not been appraised to date. Subjects undergoing MPI and reporting a history of clinical MI were shortlisted. We focused on the presence, severity, and localization of necrosis at MPI with a retrospective single-center analysis. A total of 10,476 patients were included, distinguishing 5 groups according to the period in which myocardial perfusion scintigraphy had been performed (2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, 2012 to 2013). Trend analysis showed over time a significant worsening in baseline features (e.g., age, diabetes mellitus, and Q waves at electrocardiogram), whereas medical therapy and revascularization were offered with increasing frequency. Over the years, there was also a lower prevalence of normal MPI (from 16.8% to 13.6%) and ischemic MPI (from 35.6% to 32.8%), and a higher prevalence of ischemic and necrotic MPI (from 12.0% to 12.7%) or solely necrotic MPI (from 35.7% to 40.9%, p |
| doi_str_mv | 10.1016/j.amjcard.2017.07.007 |
| format | Article |
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Whether these changes have impacted on the presence, severity, and localization of necrosis at myocardial perfusion imaging (MPI) has not been appraised to date. Subjects undergoing MPI and reporting a history of clinical MI were shortlisted. We focused on the presence, severity, and localization of necrosis at MPI with a retrospective single-center analysis. A total of 10,476 patients were included, distinguishing 5 groups according to the period in which myocardial perfusion scintigraphy had been performed (2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, 2012 to 2013). Trend analysis showed over time a significant worsening in baseline features (e.g., age, diabetes mellitus, and Q waves at electrocardiogram), whereas medical therapy and revascularization were offered with increasing frequency. Over the years, there was also a lower prevalence of normal MPI (from 16.8% to 13.6%) and ischemic MPI (from 35.6% to 32.8%), and a higher prevalence of ischemic and necrotic MPI (from 12.0% to 12.7%) or solely necrotic MPI (from 35.7% to 40.9%, p <0.001). Yet the prevalence of severe ischemia decreased over time from 11.4% to 2.0%, with a similar trend for moderate ischemia (from 15.9% to 11.8%, p <0.001). Similarly sobering results were wound for the prevalence of severe necrosis (from 19.8% to 8.2%) and moderate necrosis (from 8.5% to 7.8%, p = 0.028). These trends were largely confirmed at regional level and after propensity score matching. In conclusion, the outlook of stable patients with previous MI has substantially improved in the last decade, with a decrease in the severity of residual myocardial ischemia and necrosis, despite an apparent worsening in baseline features.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2017.07.007</identifier><identifier>PMID: 28888406</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Aged ; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - methods ; Cardiovascular disease ; Coronary Circulation - physiology ; Coronary vessels ; Diabetes mellitus ; EKG ; Electrocardiography ; Exercise Test ; Female ; Follow-Up Studies ; Gangrene ; Heart attacks ; Humans ; Ischemia ; Italy - epidemiology ; Localization ; Male ; Medical imaging ; Middle Aged ; Myocardial infarction ; Myocardial Infarction - diagnosis ; Myocardial Infarction - surgery ; Myocardial ischemia ; Myocardial Ischemia - diagnosis ; Myocardial Ischemia - epidemiology ; Myocardial Ischemia - physiopathology ; Myocardial Perfusion Imaging - methods ; Myocardial Revascularization ; Necrosis ; Necrosis - diagnosis ; Necrosis - epidemiology ; Necrosis - physiopathology ; Patients ; Perfusion ; Predictive Value of Tests ; Prevalence ; Retrospective Studies ; Risk Assessment - methods ; Risk Factors ; Scintigraphy ; Severity of Illness Index ; Tomography ; Trend analysis ; Trends ; Wounds</subject><ispartof>The American journal of cardiology, 2017-10, Vol.120 (8), p.1238-1244</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Sequoia S.A. Oct 15, 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-c10b314f10a640fa6e59c5f48025f0ac24ef2e648d4005fc54895f58eae7e8b13</citedby><cites>FETCH-LOGICAL-c440t-c10b314f10a640fa6e59c5f48025f0ac24ef2e648d4005fc54895f58eae7e8b13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1945866919?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28888406$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nudi, Francesco</creatorcontrib><creatorcontrib>Schillaci, Orazio</creatorcontrib><creatorcontrib>Di Belardino, Natale</creatorcontrib><creatorcontrib>Versaci, Francesco</creatorcontrib><creatorcontrib>Tomai, Fabrizio</creatorcontrib><creatorcontrib>Pinto, Annamaria</creatorcontrib><creatorcontrib>Neri, Giandomenico</creatorcontrib><creatorcontrib>Procaccini, Enrica</creatorcontrib><creatorcontrib>Nudi, Alessandro</creatorcontrib><creatorcontrib>Frati, Giacomo</creatorcontrib><creatorcontrib>Biondi-Zoccai, Giuseppe</creatorcontrib><title>Temporal Trends in the Prevalence, Severity, and Localization of Myocardial Ischemia and Necrosis at Myocardial Perfusion Imaging After Myocardial Infarction</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The definition, presentation, and management of myocardial infarction (MI) have changed substantially in the last decade. Whether these changes have impacted on the presence, severity, and localization of necrosis at myocardial perfusion imaging (MPI) has not been appraised to date. Subjects undergoing MPI and reporting a history of clinical MI were shortlisted. We focused on the presence, severity, and localization of necrosis at MPI with a retrospective single-center analysis. A total of 10,476 patients were included, distinguishing 5 groups according to the period in which myocardial perfusion scintigraphy had been performed (2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, 2012 to 2013). Trend analysis showed over time a significant worsening in baseline features (e.g., age, diabetes mellitus, and Q waves at electrocardiogram), whereas medical therapy and revascularization were offered with increasing frequency. Over the years, there was also a lower prevalence of normal MPI (from 16.8% to 13.6%) and ischemic MPI (from 35.6% to 32.8%), and a higher prevalence of ischemic and necrotic MPI (from 12.0% to 12.7%) or solely necrotic MPI (from 35.7% to 40.9%, p <0.001). Yet the prevalence of severe ischemia decreased over time from 11.4% to 2.0%, with a similar trend for moderate ischemia (from 15.9% to 11.8%, p <0.001). Similarly sobering results were wound for the prevalence of severe necrosis (from 19.8% to 8.2%) and moderate necrosis (from 8.5% to 7.8%, p = 0.028). These trends were largely confirmed at regional level and after propensity score matching. In conclusion, the outlook of stable patients with previous MI has substantially improved in the last decade, with a decrease in the severity of residual myocardial ischemia and necrosis, despite an apparent worsening in baseline features.</description><subject>Acute coronary syndromes</subject><subject>Aged</subject><subject>Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - methods</subject><subject>Cardiovascular disease</subject><subject>Coronary Circulation - physiology</subject><subject>Coronary vessels</subject><subject>Diabetes mellitus</subject><subject>EKG</subject><subject>Electrocardiography</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gangrene</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Italy - epidemiology</subject><subject>Localization</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - surgery</subject><subject>Myocardial ischemia</subject><subject>Myocardial Ischemia - diagnosis</subject><subject>Myocardial Ischemia - epidemiology</subject><subject>Myocardial Ischemia - physiopathology</subject><subject>Myocardial Perfusion Imaging - methods</subject><subject>Myocardial Revascularization</subject><subject>Necrosis</subject><subject>Necrosis - diagnosis</subject><subject>Necrosis - epidemiology</subject><subject>Necrosis - physiopathology</subject><subject>Patients</subject><subject>Perfusion</subject><subject>Predictive Value of Tests</subject><subject>Prevalence</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Scintigraphy</subject><subject>Severity of Illness Index</subject><subject>Tomography</subject><subject>Trend analysis</subject><subject>Trends</subject><subject>Wounds</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkd9qFDEUxoNY7Fp9BCXgTS8668lsMn-upBStC9tacL0O2cxJm2EmWZOZhfVdfFcz3bWoN4YD4cDv-87hfIS8YTBnwIr37Vz1rVahmefAyjmkgvIZmbGqrDNWs8VzMgOAPKsZr0_Jyxjb1DImihfkNK_S41DMyM819lsfVEfXAV0TqXV0eEB6F3CnOnQaL-hX3GGww_6CKtfQldeqsz_UYL2j3tCbvZ_WsMliGfUD9lY9creog482UjX8ydxhMGOctMte3Vt3Ty_NgOEvG2dU0JP_K3JiVBfx9fE_I98-fVxffc5WX66XV5erTHMOQ6YZbBaMGwaq4GBUgaLWwvAKcmFA6ZyjybHgVcMBhNGCV7UwokKFJVYbtjgj5wffbfDfR4yD7G3U2HXKoR-jZPWiLAvORJ3Qd_-grR-DS9sliouqKGo2UeJATTeIAY3cBtursJcM5JSfbOUxPznlJyEVlEn39ug-bnpsnlS_A0vAhwOA6Rw7i0FGbaeYGhtQD7Lx9j8jfgE0sbAq</recordid><startdate>20171015</startdate><enddate>20171015</enddate><creator>Nudi, Francesco</creator><creator>Schillaci, Orazio</creator><creator>Di Belardino, Natale</creator><creator>Versaci, Francesco</creator><creator>Tomai, Fabrizio</creator><creator>Pinto, Annamaria</creator><creator>Neri, Giandomenico</creator><creator>Procaccini, Enrica</creator><creator>Nudi, Alessandro</creator><creator>Frati, Giacomo</creator><creator>Biondi-Zoccai, Giuseppe</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20171015</creationdate><title>Temporal Trends in the Prevalence, Severity, and Localization of Myocardial Ischemia and Necrosis at Myocardial Perfusion Imaging After Myocardial Infarction</title><author>Nudi, Francesco ; Schillaci, Orazio ; Di Belardino, Natale ; Versaci, Francesco ; Tomai, Fabrizio ; Pinto, Annamaria ; Neri, Giandomenico ; Procaccini, Enrica ; Nudi, Alessandro ; Frati, Giacomo ; Biondi-Zoccai, Giuseppe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-c10b314f10a640fa6e59c5f48025f0ac24ef2e648d4005fc54895f58eae7e8b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute coronary syndromes</topic><topic>Aged</topic><topic>Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - methods</topic><topic>Cardiovascular disease</topic><topic>Coronary Circulation - physiology</topic><topic>Coronary vessels</topic><topic>Diabetes mellitus</topic><topic>EKG</topic><topic>Electrocardiography</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gangrene</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Italy - epidemiology</topic><topic>Localization</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Middle Aged</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - surgery</topic><topic>Myocardial ischemia</topic><topic>Myocardial Ischemia - diagnosis</topic><topic>Myocardial Ischemia - epidemiology</topic><topic>Myocardial Ischemia - physiopathology</topic><topic>Myocardial Perfusion Imaging - methods</topic><topic>Myocardial Revascularization</topic><topic>Necrosis</topic><topic>Necrosis - diagnosis</topic><topic>Necrosis - 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Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nudi, Francesco</au><au>Schillaci, Orazio</au><au>Di Belardino, Natale</au><au>Versaci, Francesco</au><au>Tomai, Fabrizio</au><au>Pinto, Annamaria</au><au>Neri, Giandomenico</au><au>Procaccini, Enrica</au><au>Nudi, Alessandro</au><au>Frati, Giacomo</au><au>Biondi-Zoccai, Giuseppe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Temporal Trends in the Prevalence, Severity, and Localization of Myocardial Ischemia and Necrosis at Myocardial Perfusion Imaging After Myocardial Infarction</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2017-10-15</date><risdate>2017</risdate><volume>120</volume><issue>8</issue><spage>1238</spage><epage>1244</epage><pages>1238-1244</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>The definition, presentation, and management of myocardial infarction (MI) have changed substantially in the last decade. Whether these changes have impacted on the presence, severity, and localization of necrosis at myocardial perfusion imaging (MPI) has not been appraised to date. Subjects undergoing MPI and reporting a history of clinical MI were shortlisted. We focused on the presence, severity, and localization of necrosis at MPI with a retrospective single-center analysis. A total of 10,476 patients were included, distinguishing 5 groups according to the period in which myocardial perfusion scintigraphy had been performed (2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, 2012 to 2013). Trend analysis showed over time a significant worsening in baseline features (e.g., age, diabetes mellitus, and Q waves at electrocardiogram), whereas medical therapy and revascularization were offered with increasing frequency. Over the years, there was also a lower prevalence of normal MPI (from 16.8% to 13.6%) and ischemic MPI (from 35.6% to 32.8%), and a higher prevalence of ischemic and necrotic MPI (from 12.0% to 12.7%) or solely necrotic MPI (from 35.7% to 40.9%, p <0.001). Yet the prevalence of severe ischemia decreased over time from 11.4% to 2.0%, with a similar trend for moderate ischemia (from 15.9% to 11.8%, p <0.001). Similarly sobering results were wound for the prevalence of severe necrosis (from 19.8% to 8.2%) and moderate necrosis (from 8.5% to 7.8%, p = 0.028). These trends were largely confirmed at regional level and after propensity score matching. In conclusion, the outlook of stable patients with previous MI has substantially improved in the last decade, with a decrease in the severity of residual myocardial ischemia and necrosis, despite an apparent worsening in baseline features.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28888406</pmid><doi>10.1016/j.amjcard.2017.07.007</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute coronary syndromes Aged Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - methods Cardiovascular disease Coronary Circulation - physiology Coronary vessels Diabetes mellitus EKG Electrocardiography Exercise Test Female Follow-Up Studies Gangrene Heart attacks Humans Ischemia Italy - epidemiology Localization Male Medical imaging Middle Aged Myocardial infarction Myocardial Infarction - diagnosis Myocardial Infarction - surgery Myocardial ischemia Myocardial Ischemia - diagnosis Myocardial Ischemia - epidemiology Myocardial Ischemia - physiopathology Myocardial Perfusion Imaging - methods Myocardial Revascularization Necrosis Necrosis - diagnosis Necrosis - epidemiology Necrosis - physiopathology Patients Perfusion Predictive Value of Tests Prevalence Retrospective Studies Risk Assessment - methods Risk Factors Scintigraphy Severity of Illness Index Tomography Trend analysis Trends Wounds |
| title | Temporal Trends in the Prevalence, Severity, and Localization of Myocardial Ischemia and Necrosis at Myocardial Perfusion Imaging After Myocardial Infarction |
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