Comparison of long-term clinical outcomes between revascularization versus medical treatment in patients with silent myocardial ischemia

Ki Hong Choi, Joo Myung Lee, Il Park, Jihoon Kim, Tae Min Rhee, Doyeon Hwang, Jonghanne Park, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Joo Yong Hahn, Dong Seop Jeong, Yang Hyun Cho, Wook Sung Kim, Kiick Sung, Mi Ja Jang, Ji Dong Sung, Jin Ho Choi, Seung Hyuk Choi, Bon Kwon KooYoung Tak Lee, Eun Kyoung Kim, Sung A. Chang, Sung Ji Park, Jin Oh Choi, Sang Chol Lee, Seung Woo Park, Young Seok Cho, Joon Young Choi, Hyeon Cheol Gwon, Jae Kuen Oh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: There have been limited and conflicting results regarding the prognostic impact of revascularization treatment on the long-term clinical outcomes of silent ischemia. The current study aimed to determine whether revascularization treatment compared with medical treatment (MT) alone reduces long-term risk of cardiac death of asymptomatic patients with objective evidence of inducible myocardial ischemia. Methods: A total of 1473 consecutive asymptomatic patients with evidence of inducible myocardial ischemia were selected from a prospective institutional registry. All patients showed at least 1 epicardial coronary stenosis with ≥50% diameter stenosis in coronary angiography. Patients were classified according to their treatment strategies. The primary outcome was cardiac death up to 10 years. Results: Among the total population, 709 patients (48.1%) received revascularization treatment including percutaneous coronary intervention (PCI, n = 558) or coronary artery bypass graft surgery (CABG, n = 151), with the remaining patients (764 patients, 51.9%) receiving MT alone. During the follow-up period, the revascularization treatment group showed a significantly lower risk of cardiac death compared with the MT alone group (25.4% vs. 33.7%, HR 0.624, 95%CI 0.498–0.781, p < 0.001). Among revascularized patients, patients with negative non-invasive stress test results after revascularization showed significantly lower risk of cardiac death compared to those with residual myocardial ischemia (8.9% vs. 18.7%, HR 0.406, 95% CI 0.175–0.942, p = 0.036). Conclusions: In patients with silent myocardial ischemia, revascularization treatment was associated with significantly lower long-term risk of cardiac death compared with the MT alone group. The current results support contemporary practice of ischemia-directed revascularization, even in patients with silent myocardial ischemia.

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

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Myocardial Ischemia
Therapeutics
Ischemia
Myocardial Revascularization
Coronary Stenosis
Percutaneous Coronary Intervention
Coronary Angiography
Exercise Test
Coronary Artery Bypass
Registries
Pathologic Constriction
Transplants

Keywords

  • Coronary artery bypass graft surgery
  • Coronary artery disease
  • Outcomes
  • Percutaneous coronary intervention
  • Silent myocardial ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of long-term clinical outcomes between revascularization versus medical treatment in patients with silent myocardial ischemia. / Choi, Ki Hong; Lee, Joo Myung; Park, Il; Kim, Jihoon; Rhee, Tae Min; Hwang, Doyeon; Park, Jonghanne; Park, Taek Kyu; Yang, Jeong Hoon; Song, Young Bin; Hahn, Joo Yong; Jeong, Dong Seop; Cho, Yang Hyun; Kim, Wook Sung; Sung, Kiick; Jang, Mi Ja; Sung, Ji Dong; Choi, Jin Ho; Choi, Seung Hyuk; Koo, Bon Kwon; Lee, Young Tak; Kim, Eun Kyoung; Chang, Sung A.; Park, Sung Ji; Choi, Jin Oh; Lee, Sang Chol; Park, Seung Woo; Cho, Young Seok; Choi, Joon Young; Gwon, Hyeon Cheol; Oh, Jae Kuen.

In: International Journal of Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Choi, KH, Lee, JM, Park, I, Kim, J, Rhee, TM, Hwang, D, Park, J, Park, TK, Yang, JH, Song, YB, Hahn, JY, Jeong, DS, Cho, YH, Kim, WS, Sung, K, Jang, MJ, Sung, JD, Choi, JH, Choi, SH, Koo, BK, Lee, YT, Kim, EK, Chang, SA, Park, SJ, Choi, JO, Lee, SC, Park, SW, Cho, YS, Choi, JY, Gwon, HC & Oh, JK 2018, 'Comparison of long-term clinical outcomes between revascularization versus medical treatment in patients with silent myocardial ischemia', International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2018.08.006
Choi, Ki Hong ; Lee, Joo Myung ; Park, Il ; Kim, Jihoon ; Rhee, Tae Min ; Hwang, Doyeon ; Park, Jonghanne ; Park, Taek Kyu ; Yang, Jeong Hoon ; Song, Young Bin ; Hahn, Joo Yong ; Jeong, Dong Seop ; Cho, Yang Hyun ; Kim, Wook Sung ; Sung, Kiick ; Jang, Mi Ja ; Sung, Ji Dong ; Choi, Jin Ho ; Choi, Seung Hyuk ; Koo, Bon Kwon ; Lee, Young Tak ; Kim, Eun Kyoung ; Chang, Sung A. ; Park, Sung Ji ; Choi, Jin Oh ; Lee, Sang Chol ; Park, Seung Woo ; Cho, Young Seok ; Choi, Joon Young ; Gwon, Hyeon Cheol ; Oh, Jae Kuen. / Comparison of long-term clinical outcomes between revascularization versus medical treatment in patients with silent myocardial ischemia. In: International Journal of Cardiology. 2018.
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abstract = "Background: There have been limited and conflicting results regarding the prognostic impact of revascularization treatment on the long-term clinical outcomes of silent ischemia. The current study aimed to determine whether revascularization treatment compared with medical treatment (MT) alone reduces long-term risk of cardiac death of asymptomatic patients with objective evidence of inducible myocardial ischemia. Methods: A total of 1473 consecutive asymptomatic patients with evidence of inducible myocardial ischemia were selected from a prospective institutional registry. All patients showed at least 1 epicardial coronary stenosis with ≥50{\%} diameter stenosis in coronary angiography. Patients were classified according to their treatment strategies. The primary outcome was cardiac death up to 10 years. Results: Among the total population, 709 patients (48.1{\%}) received revascularization treatment including percutaneous coronary intervention (PCI, n = 558) or coronary artery bypass graft surgery (CABG, n = 151), with the remaining patients (764 patients, 51.9{\%}) receiving MT alone. During the follow-up period, the revascularization treatment group showed a significantly lower risk of cardiac death compared with the MT alone group (25.4{\%} vs. 33.7{\%}, HR 0.624, 95{\%}CI 0.498–0.781, p < 0.001). Among revascularized patients, patients with negative non-invasive stress test results after revascularization showed significantly lower risk of cardiac death compared to those with residual myocardial ischemia (8.9{\%} vs. 18.7{\%}, HR 0.406, 95{\%} CI 0.175–0.942, p = 0.036). Conclusions: In patients with silent myocardial ischemia, revascularization treatment was associated with significantly lower long-term risk of cardiac death compared with the MT alone group. The current results support contemporary practice of ischemia-directed revascularization, even in patients with silent myocardial ischemia.",
keywords = "Coronary artery bypass graft surgery, Coronary artery disease, Outcomes, Percutaneous coronary intervention, Silent myocardial ischemia",
author = "Choi, {Ki Hong} and Lee, {Joo Myung} and Il Park and Jihoon Kim and Rhee, {Tae Min} and Doyeon Hwang and Jonghanne Park and Park, {Taek Kyu} and Yang, {Jeong Hoon} and Song, {Young Bin} and Hahn, {Joo Yong} and Jeong, {Dong Seop} and Cho, {Yang Hyun} and Kim, {Wook Sung} and Kiick Sung and Jang, {Mi Ja} and Sung, {Ji Dong} and Choi, {Jin Ho} and Choi, {Seung Hyuk} and Koo, {Bon Kwon} and Lee, {Young Tak} and Kim, {Eun Kyoung} and Chang, {Sung A.} and Park, {Sung Ji} and Choi, {Jin Oh} and Lee, {Sang Chol} and Park, {Seung Woo} and Cho, {Young Seok} and Choi, {Joon Young} and Gwon, {Hyeon Cheol} and Oh, {Jae Kuen}",
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TY - JOUR

T1 - Comparison of long-term clinical outcomes between revascularization versus medical treatment in patients with silent myocardial ischemia

AU - Choi, Ki Hong

AU - Lee, Joo Myung

AU - Park, Il

AU - Kim, Jihoon

AU - Rhee, Tae Min

AU - Hwang, Doyeon

AU - Park, Jonghanne

AU - Park, Taek Kyu

AU - Yang, Jeong Hoon

AU - Song, Young Bin

AU - Hahn, Joo Yong

AU - Jeong, Dong Seop

AU - Cho, Yang Hyun

AU - Kim, Wook Sung

AU - Sung, Kiick

AU - Jang, Mi Ja

AU - Sung, Ji Dong

AU - Choi, Jin Ho

AU - Choi, Seung Hyuk

AU - Koo, Bon Kwon

AU - Lee, Young Tak

AU - Kim, Eun Kyoung

AU - Chang, Sung A.

AU - Park, Sung Ji

AU - Choi, Jin Oh

AU - Lee, Sang Chol

AU - Park, Seung Woo

AU - Cho, Young Seok

AU - Choi, Joon Young

AU - Gwon, Hyeon Cheol

AU - Oh, Jae Kuen

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: There have been limited and conflicting results regarding the prognostic impact of revascularization treatment on the long-term clinical outcomes of silent ischemia. The current study aimed to determine whether revascularization treatment compared with medical treatment (MT) alone reduces long-term risk of cardiac death of asymptomatic patients with objective evidence of inducible myocardial ischemia. Methods: A total of 1473 consecutive asymptomatic patients with evidence of inducible myocardial ischemia were selected from a prospective institutional registry. All patients showed at least 1 epicardial coronary stenosis with ≥50% diameter stenosis in coronary angiography. Patients were classified according to their treatment strategies. The primary outcome was cardiac death up to 10 years. Results: Among the total population, 709 patients (48.1%) received revascularization treatment including percutaneous coronary intervention (PCI, n = 558) or coronary artery bypass graft surgery (CABG, n = 151), with the remaining patients (764 patients, 51.9%) receiving MT alone. During the follow-up period, the revascularization treatment group showed a significantly lower risk of cardiac death compared with the MT alone group (25.4% vs. 33.7%, HR 0.624, 95%CI 0.498–0.781, p < 0.001). Among revascularized patients, patients with negative non-invasive stress test results after revascularization showed significantly lower risk of cardiac death compared to those with residual myocardial ischemia (8.9% vs. 18.7%, HR 0.406, 95% CI 0.175–0.942, p = 0.036). Conclusions: In patients with silent myocardial ischemia, revascularization treatment was associated with significantly lower long-term risk of cardiac death compared with the MT alone group. The current results support contemporary practice of ischemia-directed revascularization, even in patients with silent myocardial ischemia.

AB - Background: There have been limited and conflicting results regarding the prognostic impact of revascularization treatment on the long-term clinical outcomes of silent ischemia. The current study aimed to determine whether revascularization treatment compared with medical treatment (MT) alone reduces long-term risk of cardiac death of asymptomatic patients with objective evidence of inducible myocardial ischemia. Methods: A total of 1473 consecutive asymptomatic patients with evidence of inducible myocardial ischemia were selected from a prospective institutional registry. All patients showed at least 1 epicardial coronary stenosis with ≥50% diameter stenosis in coronary angiography. Patients were classified according to their treatment strategies. The primary outcome was cardiac death up to 10 years. Results: Among the total population, 709 patients (48.1%) received revascularization treatment including percutaneous coronary intervention (PCI, n = 558) or coronary artery bypass graft surgery (CABG, n = 151), with the remaining patients (764 patients, 51.9%) receiving MT alone. During the follow-up period, the revascularization treatment group showed a significantly lower risk of cardiac death compared with the MT alone group (25.4% vs. 33.7%, HR 0.624, 95%CI 0.498–0.781, p < 0.001). Among revascularized patients, patients with negative non-invasive stress test results after revascularization showed significantly lower risk of cardiac death compared to those with residual myocardial ischemia (8.9% vs. 18.7%, HR 0.406, 95% CI 0.175–0.942, p = 0.036). Conclusions: In patients with silent myocardial ischemia, revascularization treatment was associated with significantly lower long-term risk of cardiac death compared with the MT alone group. The current results support contemporary practice of ischemia-directed revascularization, even in patients with silent myocardial ischemia.

KW - Coronary artery bypass graft surgery

KW - Coronary artery disease

KW - Outcomes

KW - Percutaneous coronary intervention

KW - Silent myocardial ischemia

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U2 - 10.1016/j.ijcard.2018.08.006

DO - 10.1016/j.ijcard.2018.08.006

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JF - International Journal of Cardiology

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