The elusive role of myocardial perfusion imaging in stable ischemic heart disease: Is ISCHEMIA the answer?

Joe X. Xie, David E. Winchester, Lawrence M. Phillips, Rory Hachamovitch, Daniel S. Berman, Ron Blankstein, Marcelo F. Di Carli, Todd D. Miller, Mouaz H. Al-Mallah, Leslee J. Shaw

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1610-1618
Number of pages9
JournalJournal of Nuclear Cardiology
Volume24
Issue number5
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

Keywords

  • Coronary artery disease
  • myocardial ischemia
  • myocardial perfusion imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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