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

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• 作者：Lawrence M. Phillips MD (1)
  Rory Hachamovitch MD ; MSc (2)
  Daniel S. Berman MD (3)
  Ami E. Iskandrian MD (4)
  James K. Min MD (5)
  Michael H. Picard MD (6)
  Raymond Y. Kwong MD (7)
  Matthias G. Friedrich MD (8)
  Marielle Scherrer-Crosbie MD ; PhD (6)
  Sean W. Hayes MD (3)
  Tali Sharir MD (9)
  Gilbert Gosselin MD (8)
  Marco Mazzanti MD (10)
  Roxy Senior MD (11)
  Rob Beanlands MD (12)
  Paola Smanio MD (13)
  Abhi Goyal MD ; MHS (14)
  Mouaz Al-Mallah MD (15)
  Harmony Reynolds MD (1)
  Gregg W. Stone MD (16)
  David J. Maron MD (17)
  Leslee J. Shaw PhD (14)
  
• 关键词：Myocardial perfusion imaging ; ischemia ; coronary artery disease ; clinical trials
• 刊名：Journal of Nuclear Cardiology
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：20
• 期：6
• 页码：969-975
• 全文大小：
• 作者单位：Lawrence M. Phillips MD (1)
  Rory Hachamovitch MD, MSc (2)
  Daniel S. Berman MD (3)
  Ami E. Iskandrian MD (4)
  James K. Min MD (5)
  Michael H. Picard MD (6)
  Raymond Y. Kwong MD (7)
  Matthias G. Friedrich MD (8)
  Marielle Scherrer-Crosbie MD, PhD (6)
  Sean W. Hayes MD (3)
  Tali Sharir MD (9)
  Gilbert Gosselin MD (8)
  Marco Mazzanti MD (10)
  Roxy Senior MD (11)
  Rob Beanlands MD (12)
  Paola Smanio MD (13)
  Abhi Goyal MD, MHS (14)
  Mouaz Al-Mallah MD (15)
  Harmony Reynolds MD (1)
  Gregg W. Stone MD (16)
  David J. Maron MD (17)
  Leslee J. Shaw PhD (14)
  
  1. New York University School of Medicine, 530 First Avenue, SKI-9U, New York, NY, 10016, USA
  2. Cleveland Clinic Foundation, Cleveland, OH, USA
  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA
  4. University of Alabama – Birmingham, Birmingham, AL, USA
  5. Weill Cornell Medical College, New York, NY, USA
  6. Massachusetts General Hospital, Boston, MA, USA
  7. Brigham and Women’s Hospital, Boston, MA, USA
  8. Montreal Heart Institute, Montreal, QC, Canada
  9. Assuta Medical Center, Tel Aviv, Israel
  10. University Hospital of Ancona, Ancona, Italy
  11. Northwick Park Hospital, London, United Kingdom
  12. Ottawa Heart Institute, Ottawa, ON, Canada
  13. Instituto Dante Pazzanese de Cardiologia, S?o Paulo, Brazil
  14. Emory University School of Medicine, Atlanta, GA, USA
  15. King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia
  16. New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
  17. Vanderbilt University, Nashville, TN, USA
  
• ISSN：1532-6551

文摘

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.