TY - JOUR
T1 - The elusive role of myocardial perfusion imaging in stable ischemic heart disease
T2 - Is ISCHEMIA the answer?
AU - Xie, Joe X.
AU - Winchester, David E.
AU - Phillips, Lawrence M.
AU - Hachamovitch, Rory
AU - Berman, Daniel S.
AU - Blankstein, Ron
AU - Di Carli, Marcelo F.
AU - Miller, Todd D.
AU - Al-Mallah, Mouaz H.
AU - Shaw, Leslee J.
N1 - Funding Information:
a Department of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia b Department of Cardiology, University of Florida College of Medicine, Gainesville, FL c Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY d Department of Cardiology, Cleveland Clinic, Cleveland, OH e Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA f Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA g Department of Cardiology, Mayo Clinic, Rochester, MN h King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
Funding Information:
Funding Funding for this research was supported by NIH-NHLBI (5T32HL007745-20).
Publisher Copyright:
© 2017, American Society of Nuclear Cardiology.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - The assessment of ischemia through myocardial perfusion imaging (MPI) is widely accepted as an index step in the diagnostic evaluation of stable ischemic heart disease (SIHD). Numerous observational studies have characterized the prognostic significance of ischemia extent and severity. However, the role of ischemia in directing downstream SIHD care including coronary revascularization has remained elusive as reductions in ischemic burden have not translated to improved clinical outcomes in randomized trials. Importantly, selection bias leading to the inclusion of many low risk patients with minimal ischemia have narrowed the generalizability of prior studies along with other limitations. Accordingly, an ongoing randomized controlled trial entitled ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) will compare an invasive coronary revascularization strategy vs a conservative medical therapy approach among stable patients with moderate to severe ischemia. The results of ISCHEMIA may have a substantial impact on the management of SIHD and better define the role of MPI in current SIHD pathways of care.
AB - The assessment of ischemia through myocardial perfusion imaging (MPI) is widely accepted as an index step in the diagnostic evaluation of stable ischemic heart disease (SIHD). Numerous observational studies have characterized the prognostic significance of ischemia extent and severity. However, the role of ischemia in directing downstream SIHD care including coronary revascularization has remained elusive as reductions in ischemic burden have not translated to improved clinical outcomes in randomized trials. Importantly, selection bias leading to the inclusion of many low risk patients with minimal ischemia have narrowed the generalizability of prior studies along with other limitations. Accordingly, an ongoing randomized controlled trial entitled ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) will compare an invasive coronary revascularization strategy vs a conservative medical therapy approach among stable patients with moderate to severe ischemia. The results of ISCHEMIA may have a substantial impact on the management of SIHD and better define the role of MPI in current SIHD pathways of care.
KW - Coronary artery disease
KW - myocardial ischemia
KW - myocardial perfusion imaging
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U2 - 10.1007/s12350-017-0963-3
DO - 10.1007/s12350-017-0963-3
M3 - Article
C2 - 28752313
AN - SCOPUS:85026904106
VL - 24
SP - 1610
EP - 1618
JO - Journal of Nuclear Cardiology
JF - Journal of Nuclear Cardiology
SN - 1071-3581
IS - 5
ER -