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Subject Area

Orthopedic Surgery

Article Type

Original Study

Abstract

Objective To compare the long-term outcomes in patients with a large perfusion defect and predominant ischemia who have revascularization and those who had medical treatment. Background Revascularization requires demonstration of its clinical benefits via studies evidencing interaction between the presence of ischemia and the efficacy of myocardial revascularization and the best way to prove that is stress imaging particularly stress myocardial perfusion imaging (MPI). Stress MPI has a well-established rule in the diagnosis of physiologically significant lesions. Patients and methods Between March 2012 and December 2012, this single-center prospective study included 213 patients with large perfusion defects with a predominant ischemia who underwent Technetium-99m Sestamibi MPI under both stress and rest conditions. The patients were followed up for hard events for 5 years for nonfatal myocardial infarction or cardiac death. Results Much harder events happened in patients with large perfusion defects with a predominant ischemia of at least 8% who had medical management only. There was no significant difference between patients with and without follow-up regarding clinical characteristics and MPI results (P > 0.05), except hypertension and dyslipidemia (P = 0.05 and 0.001, respectively). There was no significant difference between patients on medical treatment versus patients on medical treatment plus interventions regarding clinical characteristics and MPI results (P > 0.05), except age (P = 0.001), hypertension (P = 0.04), and previous myocardial infarction (P = 0.007). Conclusion In patients with chronic ischemic heart disease, patients with large perfusion defect (>10%) and predominant ischemia (>8%) will gain benefit from revascularization.

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