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

共 50 条

[31] THE IMPACT OF COMPLETE SURGICAL REVASCULARIZATION ON OUTCOMES OF PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING SURGERY: INSIGHTS FROM THE REGROUP TRIAL
Ramadan, Ronnie
Kinlay, Scott
Stock, Eileen M.
Phillips, Annette
Dematt, Ellen J.
Bhatt, Deepak
Zenati, Marco
[J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2020, 75 (11) : 1518 - 1518
[32] ROOBY trial data demonstrates revascularization had no impact on POAF
Almassi, G. Hossein
Shroyer, Annie Laurie
Collins, Joseph F.
Grover, Frederick L.
[J]. FUTURE CARDIOLOGY, 2014, 10 (02) : 157 - 157
[33] Complete revascularization to the pedal arch improves the limb salvage rate in patients with critical limb ischemia
akahori, hirokuni
Nanto, Shinsuke
Iida, Osamu
Uematsu, Masaaki
Morozumi, Takakazu
Kotani, Jyun-ichi
Watanabe, Tetsuya
Awata, Masaaki
Onishi, Toshinari
Sera, Fusako
Minamiguchi, Hitoshi
Yano, Masamichi
Yasui, Hiroki
Nagata, Seiki
[J]. CIRCULATION, 2006, 114 (18) : 820 - 821
[34] IMPACT OF CARDIAC CONDITION ON PROGNOSIS IN PATIENTS WITH CRITICAL LIMB ISCHEMIA AFTER REVASCULARIZATION
Toyoshima, Taku
Iida, Osamu
Asai, Mitsutoshi
Masuda, Masaharu
Okamoto, Shin
Ishihara, Takayuki
Nanto, Kiyonori
Kanda, Takashi
Tsujimura, Takuya
Okuno, Shota
Matsuda, Yasuhiro
Kawai, Hiroyuki
Tsuji, Aki
Hata, Yosuke
Uematsu, Hiroyuki
Sato, Yuki
Higashino, Naoko
Mano, Toshiaki
[J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2019, 73 (09) : 2113 - 2113
[35] The Impact of Revascularization Strategy on Clinical Failure, Hemodynamic Failure, and Chronic Limb-Threatening Ischemia Symptoms in the BEST-CLI Trial
Strong, Michael B.
Menard, Matthew T.
Farber, Alik
Hamz, Taye
Rosenfield, Kenneth
Chisci, Emiliano
Clavijo, Leonardo
Dake, Michael
Hawkins, Beau
Kayssi, Ahmed
McGinigle, Katharine L.
Schneider, Peter A.
Conte, Michael S.
[J]. JOURNAL OF VASCULAR SURGERY, 2023, 77 (06) : E79 - E80
[36] Revascularization impact: quality of life enhancement in chronic limb-threatening ischemia
Paius, Cristian Traian
Constantin, Vlad Denis
Carap, Alexandru
Tarus, Andrei
Tinica, Grigore
[J]. JOURNAL OF MIND AND MEDICAL SCIENCES, 2023, 10 (02): : 321 - 329
[37] IS COMPLETE REVASCULARIZATION IN THE CONVENTIONAL METHOD REALLY COMPLETE
LAVEE, J
RATH, S
TRANQUANG, H
RAANANI, P
RUDER, A
MODAN, M
NEUFELD, HN
GOOR, DA
[J]. ISRAEL JOURNAL OF MEDICAL SCIENCES, 1985, 21 (04): : 400 - 400
[38] The need for a prognosis trial of revascularization and aggressive medical therapy in patients with asymptomatic cardiac ischemia
Davies, RF
[J]. CLINICAL CARDIOLOGY, 1998, 21 (03) : 154 - 156
[39] Application and clinical implications of revascularization on chronic coronary syndromes: From COURAGE to ISCHEMIA trial
Tsigkas, Grigorios
Moulias, Athanasios
Xaplanteris, Panagiotis
Bousoula, Eleni
Tzikas, Stergios
Toutouzas, Konstantinos
Davlouros, Periklis
[J]. HELLENIC JOURNAL OF CARDIOLOGY, 2021, 62 (06) : 447 - 451
[40] EFFECTS OF REVASCULARIZATION ON MUSCULAR ISCHEMIA
CHACHQUES, JC
ELSNER, B
CASALNUOVO, CA
GIVRE, S
[J]. MEDICINA-BUENOS AIRES, 1975, 35 (06) : 641 - 641

← 1 2 3 4 5 →