Journal of Nuclear Cardiology

, Volume 20, Issue 6, pp 969–975

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

  • Lawrence M. Phillips
  • Rory Hachamovitch
  • Daniel S. Berman
  • Ami E. Iskandrian
  • James K. Min
  • Michael H. Picard
  • Raymond Y. Kwong
  • Matthias G. Friedrich
  • Marielle Scherrer-Crosbie
  • Sean W. Hayes
  • Tali Sharir
  • Gilbert Gosselin
  • Marco Mazzanti
  • Roxy Senior
  • Rob Beanlands
  • Paola Smanio
  • Abhi Goyal
  • Mouaz Al-Mallah
  • Harmony Reynolds
  • Gregg W. Stone
  • David J. Maron
  • Leslee J. Shaw
Perspective

DOI: 10.1007/s12350-013-9773-4

Cite this article as:
Phillips, L.M., Hachamovitch, R., Berman, D.S. et al. J. Nucl. Cardiol. (2013) 20: 969. doi:10.1007/s12350-013-9773-4

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.

Keywords

Myocardial perfusion imagingischemiacoronary artery diseaseclinical trials

Copyright information

© American Society of Nuclear Cardiology 2013

Authors and Affiliations

  • Lawrence M. Phillips
    • 1
  • Rory Hachamovitch
    • 2
  • Daniel S. Berman
    • 3
  • Ami E. Iskandrian
    • 4
  • James K. Min
    • 5
  • Michael H. Picard
    • 6
  • Raymond Y. Kwong
    • 7
  • Matthias G. Friedrich
    • 8
  • Marielle Scherrer-Crosbie
    • 6
  • Sean W. Hayes
    • 3
  • Tali Sharir
    • 9
  • Gilbert Gosselin
    • 8
  • Marco Mazzanti
    • 10
  • Roxy Senior
    • 11
  • Rob Beanlands
    • 12
  • Paola Smanio
    • 13
  • Abhi Goyal
    • 14
  • Mouaz Al-Mallah
    • 15
  • Harmony Reynolds
    • 1
  • Gregg W. Stone
    • 16
  • David J. Maron
    • 17
  • Leslee J. Shaw
    • 14
  1. 1.New York University School of MedicineNew YorkUSA
  2. 2.Cleveland Clinic FoundationClevelandUSA
  3. 3.Cedars-Sinai Medical CenterLos AngelesUSA
  4. 4.University of Alabama – BirminghamBirminghamUSA
  5. 5.Weill Cornell Medical CollegeNew YorkUSA
  6. 6.Massachusetts General HospitalBostonUSA
  7. 7.Brigham and Women’s HospitalBostonUSA
  8. 8.Montreal Heart InstituteMontrealCanada
  9. 9.Assuta Medical CenterTel AvivIsrael
  10. 10.University Hospital of AnconaAnconaItaly
  11. 11.Northwick Park HospitalLondonUnited Kingdom
  12. 12.Ottawa Heart InstituteOttawaCanada
  13. 13.Instituto Dante Pazzanese de CardiologiaSão PauloBrazil
  14. 14.Emory University School of MedicineAtlantaUSA
  15. 15.King Abdulaziz Cardiac CenterRiyadhSaudi Arabia
  16. 16.New York Presbyterian Hospital/Columbia University Medical CenterNew YorkUSA
  17. 17.Vanderbilt UniversityNashvilleUSA