Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA

• Type of Material: Article
• Authors: Lawrence M. Phillips, New York University; Rory Hachamovitch, Cleveland Clinic Foundation; Daniel S. Berman, Cedars-Sinai Medical Center; Ami E. Iskandrian, University of Alabama Birmingham; James K. Min, Weill Cornell Medical College; Michael H. Picard, Massachusetts General Hospital; Raymond Y. Kwong, Brigham & WomenGuos Hospital; Matthias G. Friedrich, Montreal Heart Institute; Marielle Scherrer-Crosbie, Massachusetts General Hospital; Sean W. Hayes, Cedars-Sinai Medical Center; Tali Sharir, Assuta Medical Center; Gilbert Gosselin, Montreal Heart Institute; Marco Mazzanti, University Hospital of Ancona; Roxy Senior, Northwick Park Hospital; Rob Beanlands, Ottawa Heart Insitute; Paolo Smanio, Instituto Dante Pazzanese de Cardiologia; Abhinav Goyal, Emory University; Mouaz Al-Mallah, King Abdulaziz Cardiac Center; Harmony Reynolds, New York University; Gregg W. Stone, Columbia University; David J. Maron, Vanderbilt University; Leslee J Shaw, Emory University
• Language: English
• Date: 2013-12-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 American Society of Nuclear Cardiology.
• Final Published Version (URL): http://dx.doi.org/10.1007/s12350-013-9773-4
• Title of Journal or Parent Work: Journal of Nuclear Cardiology
• ISSN: 1071-3581
• Volume: 20
• Issue: 6
• Start Page: 969
• End Page: 975
• Keywords: INTERVENTION; Cardiac & Cardiovascular Systems; Life Sciences & Biomedicine; EMISSION COMPUTED-TOMOGRAPHY; Radiology, Nuclear Medicine & Medical Imaging; OUTCOMES UTILIZING REVASCULARIZATION; ischemia; clinical trials; PROGNOSTIC VALUE; coronary artery disease; Cardiovascular System & Cardiology; MYOCARDIAL-PERFUSION SPECT; CORONARY-ARTERY-DISEASE; Science & Technology; FOLLOW-UP; Myocardial perfusion imaging; OPTIMAL MEDICAL THERAPY; VENTRICULAR-FUNCTION; FRACTIONAL FLOW RESERVE
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

There is a preponderance of evidence that, in the setting of an acute coronary syndrome, an invasive approach using coronary revascularization has a morbidity and mortality benefit. However, recent stable ischemic heart disease (SIHD) randomized clinical trials testing whether the addition of coronary revascularization to guideline-directed medical therapy (GDMT) reduces death or major cardiovascular events have been negative. Based on the evidence from these trials, the primary role of GDMT as a front line medical management approach has been clearly defined in the recent SIHD clinical practice guideline; the role of prompt revascularization is less precisely defined. Based on data from observational studies, it has been hypothesized that there is a level of ischemia above which a revascularization strategy might result in benefit regarding cardiovascular events. However, eligibility for recent negative trials in SIHD has mandated at most minimal standards for ischemia. An ongoing randomized trial evaluating the effectiveness of randomization of patients to coronary angiography and revascularization as compared to no coronary angiography and GDMT in patients with moderate-severe ischemia will formally test this hypothesis. The current review will highlight the available evidence including a review of the published and ongoing SIHD trials.