Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial

Mouaz H. Al-Mallah; Ahmed Ibrahim Ahmed; Faisal Nabi; Su Min Chang; Neal S. Kleiman; Mohammed A. Chamsi-Pasha; Alpesh Shah; Yuishi Han; William A. Zoghbi; John J. Mahmarian

doi:10.1007/s12350-021-02679-7

Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial

Mouaz H. Al-Mallah, Ahmed Ibrahim Ahmed, Faisal Nabi, Su Min Chang, Neal S. Kleiman, Mohammed A. Chamsi-Pasha, Alpesh Shah, Yuishi Han, William A. Zoghbi, John J. Mahmarian

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.

Original language	English (US)
Pages (from-to)	1100-1105
Number of pages	6
Journal	Journal of Nuclear Cardiology
Volume	29
Issue number	3
DOIs	https://doi.org/10.1007/s12350-021-02679-7
State	Published - Jun 2022

Keywords

CAD
ISCHEMIA
MPI
SPECT
Humans
Middle Aged
Risk Factors
Ischemia/diagnostic imaging
Male
Tomography, Emission-Computed, Single-Photon/methods
Myocardial Ischemia
Coronary Artery Disease/diagnostic imaging
Female
Aged

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Radiology Nuclear Medicine and imaging

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10.1007/s12350-021-02679-7

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@article{f23bd5f0af31456d85b4899e123f15de,

title = "Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial",

abstract = "BACKGROUND: 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.METHODS: 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.RESULTS: 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).CONCLUSION: 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.",

keywords = "CAD, ISCHEMIA, MPI, SPECT, Humans, Middle Aged, Risk Factors, Ischemia/diagnostic imaging, Male, Tomography, Emission-Computed, Single-Photon/methods, Myocardial Ischemia, Coronary Artery Disease/diagnostic imaging, Female, Aged",

author = "Al-Mallah, {Mouaz H.} and Ahmed, {Ahmed Ibrahim} and Faisal Nabi and Chang, {Su Min} and Kleiman, {Neal S.} and Chamsi-Pasha, {Mohammed A.} and Alpesh Shah and Yuishi Han and Zoghbi, {William A.} and Mahmarian, {John J.}",

note = "Funding Information: Funding: Dr. Al-Mallah receives support from the Houston Methodist Research Institute and Siemens. No other potential conflicts of interest relevant to this article exist. Publisher Copyright: {\textcopyright} 2021, American Society of Nuclear Cardiology.",

year = "2022",

month = jun,

doi = "10.1007/s12350-021-02679-7",

language = "English (US)",

volume = "29",

pages = "1100--1105",

journal = "Journal of Nuclear Cardiology",

issn = "1071-3581",

publisher = "Springer New York",

number = "3",

}

TY - JOUR

T1 - Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial

AU - Al-Mallah, Mouaz H.

AU - Ahmed, Ahmed Ibrahim

AU - Nabi, Faisal

AU - Chang, Su Min

AU - Kleiman, Neal S.

AU - Chamsi-Pasha, Mohammed A.

AU - Shah, Alpesh

AU - Han, Yuishi

AU - Zoghbi, William A.

AU - Mahmarian, John J.

N1 - Funding Information: Funding: Dr. Al-Mallah receives support from the Houston Methodist Research Institute and Siemens. No other potential conflicts of interest relevant to this article exist. Publisher Copyright: © 2021, American Society of Nuclear Cardiology.

PY - 2022/6

Y1 - 2022/6

N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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).CONCLUSION: 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.

AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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).CONCLUSION: 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.

KW - CAD

KW - ISCHEMIA

KW - MPI

KW - SPECT

KW - Humans

KW - Middle Aged

KW - Risk Factors

KW - Ischemia/diagnostic imaging

KW - Male

KW - Tomography, Emission-Computed, Single-Photon/methods

KW - Myocardial Ischemia

KW - Coronary Artery Disease/diagnostic imaging

KW - Female

KW - Aged

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U2 - 10.1007/s12350-021-02679-7

DO - 10.1007/s12350-021-02679-7

M3 - Article

C2 - 34324083

AN - SCOPUS:85110411704

SN - 1071-3581

VL - 29

SP - 1100

EP - 1105

JO - Journal of Nuclear Cardiology

JF - Journal of Nuclear Cardiology

IS - 3

ER -

Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial

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