Imaging phenotypes and outcomes after revascularization in chronic coronary artery disease

Excerpt

In chronic coronary artery disease (CAD), myocardial revascularization aims at treating myocardial ischemia for symptom relief or to reduce the risk of major acute cardiovascular events including myocardial infarction (MI) and death.^1,2 A meta-analysis has indicated that revascularization targeting functionally significant lesions defined by reduced fractional flow reserve (FFR) reduces the risk of death and MI as compared to medical therapy alone.³ Similarly, observational studies have found survival benefit from myocardial revascularization over medical therapy in patients with moderate to severe myocardial ischemia on non-invasive testing.⁴ However, the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) did not find reduction in risk of MI or death between such patients randomized to early invasive or conservative strategy during a median of 3.2 years of follow-up, although symptoms and quality of life improved upon revascularization.⁵ Consequently, there has been an increased interest in studying disease phenotypes that might predict prognostic benefit from revascularization in chronic CAD. …