Impact of Complete Revascularization in the ISCHEMIA Trial

被引：18

作者：

Stone, Gregg W. ^{[1
,29
]}

Ali, Ziad A. ^{[2
,3
]}

O'Brien, Sean M. ^{[4
]}

Rhodes, Grace ^{[4
]}

Genereux, Philippe ^{[5
]}

Bangalore, Sripal ^{[6
]}

Mavromatis, Kreton ^{[7
]}

Horst, Jennifer ^{[3
]}

Dressler, Ovidiu ^{[3
]}

Poh, Kian Keong ^{[8
,9
]}

Nath, Ranjit K. ^{[10
]}

Moorthy, Nagaraja ^{[11
]}

Witkowski, Adam ^{[12
]}

Dwivedi, Sudhanshu K. ^{[13
]}

Bockeria, Olga ^{[14
]}

Chen, Jiyan ^{[15
]}

Smanio, Paola E. P. ^{[16
]}

Picard, Michael H. ^{[17
,18
]}

Chaitman, Bernard R. ^{[19
]}

Berman, Daniel S. ^{[20
]}

Shaw, Leslee J. ^{[1
]}

Boden, William E. ^{[21
]}

White, Harvey D. ^{[22
,23
]}

Fremes, Stephen E. ^{[24
]}

Rosenberg, Yves ^{[25
]}

Reynolds, Harmony R. ^{[6
]}

Spertus, John A. ^{[26
,27
]}

Hochman, Judith S. ^{[6
]}

Maron, D. J.

机构：

[1] Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY USA

[2] St Francis Hosp, Roslyn, NY USA

[3] Cardiovasc Res Fdn, New York, NY USA

[4] Duke Clin Res Inst, Durham, NC USA

[5] Morristown Med Ctr, Gagnon Cardiovasc Inst, Morristown, NJ USA

[6] NYU, Grossman Sch Med, New York, NY USA

[7] Emory Univ, Sch Med, Atlanta, GA USA

[8] Natl Univ Singapore, Natl Univ Heart Ctr Singapore, Singapore, Singapore

[9] Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore

[10] Dr Ram Manohar Lohia Hosp, New Delhi, India

[11] Sri Jayadeva Inst Cardiovasc Sci & Res, Bangalore, Karnataka, India

[12] Natl Inst Cardiol, Warsaw, Poland

[13] King George Med Univ, Lucknow, Up, India

[14] Natl Res Ctr Cardiovasc Surg, Moscow, Russia

[15] Guangdong Prov Peoples Hosp, Guangzhou, Guangdong, Peoples R China

[16] Inst Dante Pazzanese Cardiol & Fleury Med & Saude, Sao Paulo, Brazil

[17] Massachusetts Gen Hosp, Boston, MA USA

[18] Harvard Med Sch, Boston, MA USA

[19] St Louis Univ, Sch Med, Ctr Comprehens Cardiovasc Care, St Louis, MO USA

[20] Cedars Sinai Med Ctr, Los Angeles, CA USA

[21] Boston Univ, Sch Med, Boston, MA USA

[22] Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand

[23] Univ Auckland, Auckland, New Zealand

[24] Univ Toronto, Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[25] NHLBI, Washington, DC USA

[26] St Lukes Mid Amer Heart Inst, Kansas City, MO USA

[27] Univ Missouri, Kansas City, MO USA

[28] Stanford Sch Med, Dept Med, Stanford, CA USA

[29] Mt Sinai Med Ctr, 1 Gustave L Levy Pl, New York, NY 10029 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2023年 / 82卷 / 12期

基金：

美国国家卫生研究院;

关键词：

complete revascularization; coronary artery disease; ischemia; prognosis; revascularization; PERCUTANEOUS CORONARY INTERVENTION; FRACTIONAL FLOW RESERVE; INCOMPLETE REVASCULARIZATION; OUTCOMES; SURGERY;

D O I：

10.1016/j.jacc.2023.06.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Anatomic complete revascularization (ACR) and functional complete revascularization (FCR) have been associated with reduced death and myocardial infarction (MI) in some prior studies. The impact of complete revascularization (CR) in patients undergoing an invasive (INV) compared with a conservative (CON) management strategy has not been reported.OBJECTIVES Among patients with chronic coronary disease without prior coronary artery bypass grafting randomized to INV vs CON management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, we examined the following: 1) the outcomes of ACR and FCR compared with incomplete revascularization; and 2) the potential impact of achieving CR in all INV patients compared with CON management.METHODS ACR and FCR in the INV group were assessed at an independent core laboratory. Multivariable-adjusted outcomes of CR were examined in INV patients. Inverse probability weighted modeling was then performed to estimate the treatment effect had CR been achieved in all INV patients compared with CON management.RESULTS ACR and FCR were achieved in 43.4% and 58.4% of 1,824 INV patients. ACR was associated with reduced 4-year rates of cardiovascular death or MI compared with incomplete revascularization. By inverse probability weighted modeling, ACR in all 2,296 INV patients compared with 2,498 CON patients was associated with a lower 4-year rate of cardiovascular death or MI (difference-3.5; 95% CI:-7.2% to 0.0%). In comparison, the event rate difference of cardiovascular death or MI for INV minus CON in the overall ISCHEMIA trial was-2.4%. Results were similar but less pronounced with FCR.CONCLUSIONS The outcomes of an INV strategy may be improved if CR (especially ACR) is achieved. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522)(J Am Coll Cardiol 2023;82:1175-1188) (c) 2023 by the American College of Cardiology Foundation.

引用

页码：1175 / 1188

页数：14

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