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Prognostic impact of patients’ management based on anatomic/functional phenotype: a study in patients with chronic coronary syndromes

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

In stable coronary artery disease (CAD), the prognostic interaction between clinical variables and treatment appropriateness based on anatomic/functional phenotype needs to be evaluated.

Methods

1585 consecutive patients underwent myocardial perfusion scintigraphy and coronary angiography within 90 days. Obstructive CAD (> 70% stenosis) with downstream moderate-to-severe ischemia (> 10%) was considered significant. Coronary revascularization was considered appropriate if all hemodynamically significant lesions were revascularized, while medical therapy only was deemed appropriate in the absence of hemodynamically significant CAD.

Results

Obstructive CAD and moderate-to-severe ischemia were documented in 1184 (75%) and 466 (29%) patients, respectively. Over mean follow-up of 4.7 ± 2.5 years, the primary endpoint (cardiac death and non-fatal myocardial infarction) occurred in 132 (8.2%) patients. Of patients with obstructive CAD, 797 (67%) were managed appropriately. Patients’ management was inappropriate in 389 patients, because either non-hemodynamically significant lesions were revascularized (50%, including 2 patients with non-obstructive lesions being inappropriately revascularized) or ischemia-causing CAD was left untreated (50%). At multivariate analysis, an inappropriate management (P < .001) was correlated with the primary endpoint, together with previous myocardial infarction (P = .009), lower ejection fraction (P < .001) and higher glucose levels (P < .001).

Conclusions

In stable CAD patients, management based on anatomic/functional phenotyping was correlated with a prognostic advantage at long-term follow-up.

Graphical abstract

Correlation between treatment categories and patients’ prognosis. A significantly higher event-rate was observed in patients where hemodynamically significant coronary lesions were left untreated—either because MT was not-adherently chosen or in the case of incomplete revascularization—than in those that were revascularized completely (17.6% vs 5.1%; P < .001). Conversely, the revascularization of non-hemodynamically significant CAD correlated with a higher event-rate than that of similar patients managed medically (13.8% vs 8.3%, P = .04). The event-rate of patients in whom coronary revascularization was performed in the presence of hemodynamically significant CAD (‘appropriate revascularization’) was similar to those with “No CAD/non-obstructive CAD” (5.1% vs 3.5%; P = NS).

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Abbreviations

MPS:

Myocardial perfusion scintigraphy

CAD:

Coronary artery disease

CZT:

Cadmium-Zinc-Telluride

ICA:

Invasive coronary angiography

CTCA:

Computed tomography coronary angiography

SDS:

Summed difference score

MI:

Myocardial infarction

LVEF:

Left ventricular ejection fraction

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Disclosure

The authors have indicated that they have no financial conflict of interest.

Ethical approval

The study conformed to the declaration of Helsinki and was approved by the Institution’s human research committee.

Informed consent

All participants gave written informed consent.

Author information

Authors and Affiliations

  1. Dipartimento Cardio-Toracico e Vascolare, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy

    Riccardo Liga MD, PhD, FESC

  2. Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell’Area Critica, Università di Pisa, Pisa, Italy

    Riccardo Liga MD, PhD, FESC

  3. Cardiovascular and Imaging Departments, CNR Research Area, Fondazione CNR/Regione Toscana Gabriele Monasterio, Via G. Moruzzi 1, 56124, Pisa, Italy

    Danilo Neglia MD, PhD, FESC, Samuele Cavaleri RT, Enrico Grasso RT, Assuero Giorgetti MD & Alessia Gimelli MD, FESC

  4. Scuola Superiore Sant’Anna, Pisa, Italy

    Danilo Neglia MD, PhD, FESC

Authors
  1. Riccardo Liga MD, PhD, FESC
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  2. Danilo Neglia MD, PhD, FESC
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  3. Samuele Cavaleri RT
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  4. Enrico Grasso RT
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  5. Assuero Giorgetti MD
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  6. Alessia Gimelli MD, FESC
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Correspondence to Alessia Gimelli MD, FESC.

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Liga, R., Neglia, D., Cavaleri, S. et al. Prognostic impact of patients’ management based on anatomic/functional phenotype: a study in patients with chronic coronary syndromes. J. Nucl. Cardiol. 30, 736–747 (2023). https://doi.org/10.1007/s12350-022-03070-w

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  • DOI: https://doi.org/10.1007/s12350-022-03070-w

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