Document Detail

Influence of typical angina versus inducible myocardial ischemia in the contemporary management of stable coronary artery disease.
MedLine Citation:
PMID:  24759611     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To investigate, in patients with known or suspected coronary artery disease (CAD) undergoing myocardial perfusion single-photon emission computed tomography (MPS), the interaction between patient symptoms and single-photon emission computed tomography (SPECT) results, and their effects on patient outcomes. Previous data have shown that medical treatment may be as beneficial as invasive treatment for most patients with stable CAD. Nonetheless, patient presentation with typical angina (TA) seems to still lead to more aggressive management, regardless of the amount of myocardial ischemia detected by noninvasive methods.
METHODS: Over 33 ± 20 months, 2958 patients undergoing stress/rest cardiac SPECT were followed. Summed stress, rest and difference scores (SSS, SRS and SDS, respectively) were analyzed. Abnormal SPECT was defined as a SSS>3, and ischemic SPECT as a SDS>1. During follow up, cardiac catheterization (CATH), myocardial revascularization (either percutaneous or surgical), myocardial infarction (MI) and all-cause death were evaluated.
RESULTS: TA was found in 228 patients (7.7%). Comparing patients with TA with those without it, the former more often had had abnormal (43.0% versus 34.3%, p < 0.001) and ischemic SPECT (25.9% versus 13.6%, p < 0.001). Also, higher rates of MI (2.0% versus 0.6%, p < 0.001), CATH (10.1% versus 4.7%, p < 0.001) and revascularization (7.8% versus 3.0%, p < 0.001) were observed, while death was not significantly different (1.5% versus 1.0%, p = 0.2). Even in the absence of ischemia in SPECT, patients with TA had higher CATH and revascularization rates; death, again, was not significantly increased.
CONCLUSION: Although patients with TA more often had ischemic SPECT, all-cause death was not significantly increased. Nonetheless, TA was associated with more frequent referrals for CATH and revascularization, even with nonischemic SPECT. This may suggest that despite current evidence, the management of stable patients with known or suspected CAD is influenced by symptom type.
Andrea De Lorenzo; Gabriel Oliveira; Vania M Naue; Ronaldo S L Lima
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-23
Journal Detail:
Title:  Therapeutic advances in cardiovascular disease     Volume:  -     ISSN:  1753-9455     ISO Abbreviation:  Ther Adv Cardiovasc Dis     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101316343     Medline TA:  Ther Adv Cardiovasc Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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