Two-year follow-up of myocardial revascularization after anatomical and functional screening for myocardial ischemia: Insights from the “Nancy Ischemia Registry”

Abstract

Introduction

Myocardial revascularization after screening for myocardial ischemia is one of the main Major Adverse Cardiovascular Events (MACE) observed. Careful monitoring of patients could play an important role.

Objective

Systematic monitoring of patients after a myocardial revascularization procedure is known from randomized clinical trials. A real follow-up outside of this context is not really known. In a real world, Nancy Ischemia Registry aims to prospectively study the consequences of screening for myocardial ischemia on subsequent myocardial revascularization.

Method

After prospectively including 2977 patients as part of screening for myocardial ischemia by anatomical (Coronary Calcium-Scores, CT-Coronary Angiograms) and functional imaging (Stress Echo, Stress CMR) between May 2021 and the end of December 2022, we observed the occurrence of a myocardial revascularization procedure in these patients. After a positive screening for myocardial ischemia, a coronary angiography was performed. A first myocardial revascularization procedure was decided if the patient presented at least one significant coronary lesion (≥ 70% or FFR ≤ 0.80).

Results

In 2,375 patients, screening did not reveal significant myocardial ischemia (ISCHEMIA −). We noted 602 examinations (20% of all examinations) with suspicion of myocardial ischemia (ISCHEMIA +). 324 patients (11% of all examinations) (REAVASC +) benefited from a first myocardial revascularization in the following weeks. All patients in the three groups had usual follow-up. At the end of 2023, in the ISCHEMIA − group, we had recorded two cases of myocardial revascularization. In the ISCHEMIA + group, 97 new revascularization interventions were recorded. However, at least one other myocardial revascularization procedure was observed in 73 patients in the REVASC + group.

Conclusion

Far from the context of randomized clinical trials, non-systematic, but regular, monitoring of patients with suspected myocardial ischemia and/or revascularization shows the interest of anatomical and functional imaging to probably avoid a more significant evolution of MACE and allows for better stratification of patients.