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Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction. Mentz, Robert J Fiuzat, Mona Shaw, Linda K Farzaneh-Far, Afshin M O'Connor, Christopher Borges-Neto, Salvador
dc.coverage.spatial England 2018-03-01T15:33:03Z 2018-03-01T15:33:03Z 2015
dc.identifier openhrt-2015-000284
dc.identifier.issn 2053-3624
dc.description.abstract OBJECTIVE: Nuclear imaging data demonstrate that revascularisation leads to favourable effects on ischaemia burden and improved outcomes compared with medical therapy (MT). In patients with heart failure (HF), the effects of MT versus revascularisation on ischaemia change and its independent prognostic significance requires investigation. METHODS: From the Duke Databank, we performed a retrospective analysis of 278 consecutive patients with coronary artery disease (CAD) and ejection fraction (EF) ≤40%, who underwent 2 serial myocardial perfusion scans between 1993 and 2009. Ischaemia change was calculated for patients undergoing MT alone, or revascularisation. Cox proportional hazards regression modelling was used to identify factors associated with death/myocardial infarction (MI). RESULTS: The magnitude of ischeamia reduction was greater with revascularisation than with MT alone (median change of -6% vs 0%, p<0.001). With revascularisation, more patients experienced ≥5% ischaemia reduction compared with MT (52% vs 25%, p<0.01) and a similar percentage experienced ≥5% ischaemia worsening (13% vs 18%, p=0.37). After risk adjustment, ≥5% ischaemia worsening was associated with decreased death/MI (HR=0.58; 95% CI 0.36 to 0.96). CONCLUSIONS: In patients with HF with CAD, revascularisation improves long-term ischaemia burden compared with MT. Ischaemia worsening on nuclear imaging was associated with reduced risk of death/MI, potentially related to development of ischaemic viable myocardium as opposed to scar tissue.
dc.language eng
dc.publisher BMJ
dc.relation.ispartof Open Heart
dc.relation.isversionof 10.1136/openhrt-2015-000284
dc.title Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction.
dc.type Journal article Mentz, Robert J|0538574 Fiuzat, Mona|0495311 Farzaneh-Far, Afshin|0435933 Borges-Neto, Salvador|0096093
pubs.begin-page e000284
pubs.issue 1
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group Radiology
pubs.organisational-group Radiology, Nuclear Medicine
pubs.organisational-group School of Medicine
pubs.publication-status Published online
pubs.volume 2
duke.contributor.orcid Mentz, Robert J|0000-0002-3222-1719
duke.contributor.orcid Farzaneh-Far, Afshin|0000-0002-2011-8466

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