Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial
The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial showed no difference in outcomes between medical therapy vs coronary revascularization in the management of patients with stable coronary artery disease. We aimed to determine the percen...
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| Veröffentlicht in: | Journal of nuclear cardiology 2022-06, Vol.29 (3), p.1100-1105 |
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| creator | Al-Mallah, Mouaz H. Ahmed, Ahmed Ibrahim Nabi, Faisal Chang, Su Min Kleiman, Neal S. Chamsi-Pasha, Mohammed A. Shah, Alpesh Han, Yuishi Zoghbi, William A. Mahmarian, John J. |
| description | The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial showed no difference in outcomes between medical therapy vs coronary revascularization in the management of patients with stable coronary artery disease. We aimed to determine the percentage of patients with at least moderate ischemia that would have been eligible for enrollment and evaluate the outcomes of those who would not.
Consecutive patients who underwent cardiac single-photon emission computed tomography (SPECT) between April 2016 and September 2019 were identified and all-cause mortality was determined.
There were a total of 1508 patients (mean age 67 ± 11.6 years, 69.5% males) with any perfusion defect on SPECT. Patients had a high prevalence of cardiac risk factors (73.4% with hypertension and 54.4% with diabetes mellitus.) Nearly half (709, 47%) had moderate-to-severe ischemia but over two-thirds (479/709, 66.3%) had at least one ISCHEMIA trial exclusion criteria. Patients meeting ISCHEMIA enrollment criteria had a significantly lower all-cause mortality than those who would have been excluded (3.91% vs. 11.3%, respectively, P < .001).
Our results show that ISCHEMIA selected a relatively small subset of lower risk patients among the larger higher risk group of patients with moderate-to-severe ischemia typical to most cardiology centers. |
| doi_str_mv | 10.1007/s12350-021-02679-7 |
| format | Article |
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Consecutive patients who underwent cardiac single-photon emission computed tomography (SPECT) between April 2016 and September 2019 were identified and all-cause mortality was determined.
There were a total of 1508 patients (mean age 67 ± 11.6 years, 69.5% males) with any perfusion defect on SPECT. Patients had a high prevalence of cardiac risk factors (73.4% with hypertension and 54.4% with diabetes mellitus.) Nearly half (709, 47%) had moderate-to-severe ischemia but over two-thirds (479/709, 66.3%) had at least one ISCHEMIA trial exclusion criteria. Patients meeting ISCHEMIA enrollment criteria had a significantly lower all-cause mortality than those who would have been excluded (3.91% vs. 11.3%, respectively, P < .001).
Our results show that ISCHEMIA selected a relatively small subset of lower risk patients among the larger higher risk group of patients with moderate-to-severe ischemia typical to most cardiology centers.</description><identifier>ISSN: 1071-3581</identifier><identifier>EISSN: 1532-6551</identifier><identifier>DOI: 10.1007/s12350-021-02679-7</identifier><identifier>PMID: 34324083</identifier><language>eng</language><publisher>Cham: Elsevier Inc</publisher><subject>Aged ; Brief Report ; CAD ; Cardiology ; Cardiovascular disease ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - epidemiology ; Coronary Artery Disease - therapy ; Female ; Humans ; Imaging ; ISCHEMIA ; Ischemia - diagnostic imaging ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; MPI ; Myocardial Ischemia ; Nuclear Medicine ; Radiology ; Risk Factors ; SPECT ; Tomography, Emission-Computed, Single-Photon - methods</subject><ispartof>Journal of nuclear cardiology, 2022-06, Vol.29 (3), p.1100-1105</ispartof><rights>2022 American Society of Nuclear Cardiology. Published by ELSEVIER INC. All rights reserved.</rights><rights>American Society of Nuclear Cardiology 2021</rights><rights>2021. American Society of Nuclear Cardiology.</rights><rights>American Society of Nuclear Cardiology 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-9b89b99364fdf301934322f03f4176cf616f80c55e017422a4e6c8a6a7a3bb843</citedby><cites>FETCH-LOGICAL-c428t-9b89b99364fdf301934322f03f4176cf616f80c55e017422a4e6c8a6a7a3bb843</cites><orcidid>0000-0002-5886-7999</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12350-021-02679-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12350-021-02679-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34324083$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Al-Mallah, Mouaz H.</creatorcontrib><creatorcontrib>Ahmed, Ahmed Ibrahim</creatorcontrib><creatorcontrib>Nabi, Faisal</creatorcontrib><creatorcontrib>Chang, Su Min</creatorcontrib><creatorcontrib>Kleiman, Neal S.</creatorcontrib><creatorcontrib>Chamsi-Pasha, Mohammed A.</creatorcontrib><creatorcontrib>Shah, Alpesh</creatorcontrib><creatorcontrib>Han, Yuishi</creatorcontrib><creatorcontrib>Zoghbi, William A.</creatorcontrib><creatorcontrib>Mahmarian, John J.</creatorcontrib><title>Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial</title><title>Journal of nuclear cardiology</title><addtitle>J. Nucl. Cardiol</addtitle><addtitle>J Nucl Cardiol</addtitle><description>The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial showed no difference in outcomes between medical therapy vs coronary revascularization in the management of patients with stable coronary artery disease. We aimed to determine the percentage of patients with at least moderate ischemia that would have been eligible for enrollment and evaluate the outcomes of those who would not.
Consecutive patients who underwent cardiac single-photon emission computed tomography (SPECT) between April 2016 and September 2019 were identified and all-cause mortality was determined.
There were a total of 1508 patients (mean age 67 ± 11.6 years, 69.5% males) with any perfusion defect on SPECT. Patients had a high prevalence of cardiac risk factors (73.4% with hypertension and 54.4% with diabetes mellitus.) Nearly half (709, 47%) had moderate-to-severe ischemia but over two-thirds (479/709, 66.3%) had at least one ISCHEMIA trial exclusion criteria. Patients meeting ISCHEMIA enrollment criteria had a significantly lower all-cause mortality than those who would have been excluded (3.91% vs. 11.3%, respectively, P < .001).
Our results show that ISCHEMIA selected a relatively small subset of lower risk patients among the larger higher risk group of patients with moderate-to-severe ischemia typical to most cardiology centers.</description><subject>Aged</subject><subject>Brief Report</subject><subject>CAD</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - epidemiology</subject><subject>Coronary Artery Disease - therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Imaging</subject><subject>ISCHEMIA</subject><subject>Ischemia - diagnostic imaging</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>MPI</subject><subject>Myocardial Ischemia</subject><subject>Nuclear Medicine</subject><subject>Radiology</subject><subject>Risk Factors</subject><subject>SPECT</subject><subject>Tomography, Emission-Computed, Single-Photon - methods</subject><issn>1071-3581</issn><issn>1532-6551</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1rHSEUhqW0NGnaP9BFELrpxtSPUUfIJoR-BALZtN2K4xx7DTPXG3XS9t_H28kHdJGFKJznPefwiNB7Rk8YpfpTYVxISihn7ShtiH6BDpkUnCgp2cv2ppoRIXt2gN6Uck0pNcKY1-hAdIJ3tBeH6OfVUn2aoeAU8M7VCNta8O9YN3hOI2RXgdRECtxCBnxR_Abm6DD88dMywohDTjOuG8DxoVRzdNNb9Cq4qcC7-_sI_fjy-fv5N3J59fXi_OyS-I73lZihN4MxQnVhDIIys1-MBypCx7TyQTEVeuqlBMp0x7nrQPneKaedGIa-E0fo49p3l9PNAqXauS0C0-S2kJZiuZRKNK5XDf3wH3qdlrxt29kmj2uhOd9TfKV8TqVkCHaX4-zyX8uo3Vu3q3XbrNt_1q1uoeP71ssww_gYedDcALECpZW2vyA_zX627emagmbwNrZU8e1_PIwxg692TPG5-B1yCp9E</recordid><startdate>20220601</startdate><enddate>20220601</enddate><creator>Al-Mallah, Mouaz H.</creator><creator>Ahmed, Ahmed Ibrahim</creator><creator>Nabi, Faisal</creator><creator>Chang, Su Min</creator><creator>Kleiman, Neal S.</creator><creator>Chamsi-Pasha, Mohammed A.</creator><creator>Shah, Alpesh</creator><creator>Han, Yuishi</creator><creator>Zoghbi, William A.</creator><creator>Mahmarian, John J.</creator><general>Elsevier Inc</general><general>Springer International Publishing</general><general>Springer Nature B.V</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>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5886-7999</orcidid></search><sort><creationdate>20220601</creationdate><title>Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial</title><author>Al-Mallah, Mouaz H. ; Ahmed, Ahmed Ibrahim ; Nabi, Faisal ; Chang, Su Min ; Kleiman, Neal S. ; Chamsi-Pasha, Mohammed A. ; Shah, Alpesh ; Han, Yuishi ; Zoghbi, William A. ; Mahmarian, John J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-9b89b99364fdf301934322f03f4176cf616f80c55e017422a4e6c8a6a7a3bb843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Brief Report</topic><topic>CAD</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - epidemiology</topic><topic>Coronary Artery Disease - therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Imaging</topic><topic>ISCHEMIA</topic><topic>Ischemia - diagnostic imaging</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>MPI</topic><topic>Myocardial Ischemia</topic><topic>Nuclear Medicine</topic><topic>Radiology</topic><topic>Risk Factors</topic><topic>SPECT</topic><topic>Tomography, Emission-Computed, Single-Photon - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Al-Mallah, Mouaz H.</creatorcontrib><creatorcontrib>Ahmed, Ahmed Ibrahim</creatorcontrib><creatorcontrib>Nabi, Faisal</creatorcontrib><creatorcontrib>Chang, Su Min</creatorcontrib><creatorcontrib>Kleiman, Neal S.</creatorcontrib><creatorcontrib>Chamsi-Pasha, Mohammed A.</creatorcontrib><creatorcontrib>Shah, Alpesh</creatorcontrib><creatorcontrib>Han, Yuishi</creatorcontrib><creatorcontrib>Zoghbi, William A.</creatorcontrib><creatorcontrib>Mahmarian, John J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of nuclear cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Al-Mallah, Mouaz H.</au><au>Ahmed, Ahmed Ibrahim</au><au>Nabi, Faisal</au><au>Chang, Su Min</au><au>Kleiman, Neal S.</au><au>Chamsi-Pasha, Mohammed A.</au><au>Shah, Alpesh</au><au>Han, Yuishi</au><au>Zoghbi, William A.</au><au>Mahmarian, John J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial</atitle><jtitle>Journal of nuclear cardiology</jtitle><stitle>J. Nucl. Cardiol</stitle><addtitle>J Nucl Cardiol</addtitle><date>2022-06-01</date><risdate>2022</risdate><volume>29</volume><issue>3</issue><spage>1100</spage><epage>1105</epage><pages>1100-1105</pages><issn>1071-3581</issn><eissn>1532-6551</eissn><abstract>The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial showed no difference in outcomes between medical therapy vs coronary revascularization in the management of patients with stable coronary artery disease. We aimed to determine the percentage of patients with at least moderate ischemia that would have been eligible for enrollment and evaluate the outcomes of those who would not.
Consecutive patients who underwent cardiac single-photon emission computed tomography (SPECT) between April 2016 and September 2019 were identified and all-cause mortality was determined.
There were a total of 1508 patients (mean age 67 ± 11.6 years, 69.5% males) with any perfusion defect on SPECT. Patients had a high prevalence of cardiac risk factors (73.4% with hypertension and 54.4% with diabetes mellitus.) Nearly half (709, 47%) had moderate-to-severe ischemia but over two-thirds (479/709, 66.3%) had at least one ISCHEMIA trial exclusion criteria. Patients meeting ISCHEMIA enrollment criteria had a significantly lower all-cause mortality than those who would have been excluded (3.91% vs. 11.3%, respectively, P < .001).
Our results show that ISCHEMIA selected a relatively small subset of lower risk patients among the larger higher risk group of patients with moderate-to-severe ischemia typical to most cardiology centers.</abstract><cop>Cham</cop><pub>Elsevier Inc</pub><pmid>34324083</pmid><doi>10.1007/s12350-021-02679-7</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-5886-7999</orcidid></addata></record> |
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| ispartof | Journal of nuclear cardiology, 2022-06, Vol.29 (3), p.1100-1105 |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Aged Brief Report CAD Cardiology Cardiovascular disease Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - epidemiology Coronary Artery Disease - therapy Female Humans Imaging ISCHEMIA Ischemia - diagnostic imaging Male Medicine Medicine & Public Health Middle Aged Mortality MPI Myocardial Ischemia Nuclear Medicine Radiology Risk Factors SPECT Tomography, Emission-Computed, Single-Photon - methods |
| title | Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial |
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