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87 Residual Ischaemia Post Acute Coronary Syndrome (ACS) – Does Revascularisation Improve Prognosis?
  1. Neha Sekhri1,
  2. Kenneth Fung1,
  3. Mohammed H Iqbal2,
  4. Mohammed O Anwar2,
  5. Daniel A Jones1,
  6. Anthony Mathur1,
  7. Andrew Wragg1,
  8. Adam Timmis1
  1. 1Barts Heart Centre
  2. 2Barts and the London School of Medicine and Dentistry

Abstract

Background Residual myocardial ischaemia early after acute coronary syndromes (ACS) is commonly regarded as an adverse prognostic sign and an indication for revascularisation.

However, the benefits of revascularisation for improving prognosis are not known.

Methods Analysis of 597 consecutive patients with ACS treated with coronary stenting, all of whom underwent adenosine stress cardiac magnetic resonance (CMR) perfusion imaging to guide revascularisation decisions. Follow-up data were obtained from hospital electronic health records.

Results The 597 patients (age 59 ± 12 years, 20% female) underwent stress CMR scan, at median of 93 days (IQR: 41, 224 days) after coronary stenting with follow-up  for 1.4 years (IQR: 0.6-2.7). Inducible perfusion defects were identified in 293 (49%) patients of whom 18 (6%) died during follow-up compared with 6 (2.0%) patients with no perfusion defects (p=0.01).

Of the 293 patients with perfusion defects (Table 1), 70 (24%) were revascularised (PCI 54, CABG 26) of whom 5 (7%) died during follow-up compared with 13 (6%) who were not evascularised (p=0.66). K-M survival analysis confirmed that revascularisation was unassociated with survival benefit, regardless of the severity of ischaemia (Figure 1).

Abstract 87 Table 1

Baseline characteristics in patients with perfusion defects (n = 293) stratified by revascularisation

Abstract 87 Figure 1

Probability of all cause mortality in patients with perfusion defect stratified by revascularisation

Conclusion In our patients with ACS and coronary stenting, inducible ischaemia was associated with increased risk of death during follow-up. Revascularisation did not appear to reduce the risk and should be reserved for improving symptoms in patients on optimal medical therapy.

  • Perfusion defect
  • Revascularisation
  • Prognosis

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