Better Outcomes With Early CABG vs PCI in Patients With Ischemic Heart Disease and Low MFR

The following article is part of conference coverage from the American College of Cardiology (ACC.20) /World Congress of Cardiology. The Cardiology Advisor‘s staff is reporting on research conducted by leading experts in cardiology. Check back for the latest news from the ACC.20.

The estimation of myocardial flow reserve using positron emission tomography (PET) may help identify patients with ischemic heart failure who would have improved outcomes with early coronary artery bypass grafting (CABG) vs percutaneous coronary intervention (PCI), according to study results intended to be presented at the annual meeting of the American College of Cardiology (ACC.20).

Myocardial flow reserve has been established as a reliable indicator in patients with coronary artery disease who may benefit from early interventions to revascularize the heart; however, it has not yet been investigated as a resource in patients with ischemic heart disease.

Therefore, researchers conducted a retrospective study using data from 263 patients with ischemic heart failure who had received a stress/rest PET scan for myocardial perfusion. Study participants were stratified into 5 groups: no early revascularization, early PCI, early CABG, and the presence of low myocardial reserve flow or significant myocardium at risk (ie, ischemia and/or viability ≥10%). The primary endpoint of the study was the development of any major adverse cardiac event.

A total of 20% of patients underwent revascularization within 90 days, 10% received early PCI, and another 10% received early CABG. Over a median of 3.3 years of follow-up, major adverse cardiac events occurred in 66% of patients. In patients showing low myocardial reserve flow on PET, the yearly frequency of major adverse cardiac events was lower in patients who received early CABG compared with patients who received early PCI (8% vs 40%, respectively; P =.035), as well as compared with patients who had no early revascularization (8% vs 33%, respectively; P =.018).

In patients with high myocardial flow reserve, the yearly rate of major adverse cardiac events was comparable in patients who received early CABG compared with early PCI (11% vs 17%, respectively; P =.359) or no revascularization (11% vs. 17%, respectively; P =.283).

The rate of major adverse cardiac events was comparable in patients who received early PCI vs no revascularization (40% vs 33%, respectively; P =.615). Response to treatment was similar in patients considered to have myocardium at risk (P >.05 for all).

Reference

Benz D, Kaufmann PA, von Felten E, et al. Myocardial flow reserve from position emission tomography predicts treatment response in patients with ischemic heart failure. Intended to be presented at: American College of Cardiology’s 69th Annual Scientific Session. March 28-30, 2020; Chicago, IL. Presentation 916-05.

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