Association of medical therapies with survival according to SPECT MPI findings

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology Pub Date : 2025-07-01 DOI:10.1016/j.nuclcard.2025.102229

Waseem Hijazi MD , Yuanchao Feng MSc , Danielle A. Southern MSc , Derek Chew MD, MSC , Neil Filipchuk MD , Ilias Mylonas MD , Mustapha Kazmi MD , Hamid Banijamali MD , Bryan Har MD, MSc , Matthew James MD, PhD , Stephen Wilton MD, MSc , Piotr J. Slomka PhD , Daniel Berman MD , Robert JH. Miller MD

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引用次数: 0

Abstract

Background

Myocardial perfusion imaging (MPI) results in downstream changes to medication prescription. While the benefits of medical therapy for coronary artery disease (CAD) are established, how this varies with MPI findings is unknown. Our goal was to evaluate the association of medical therapy with survival among patients undergoing MPI, including differential associations as a function of imaging findings.

Methods

Consecutive patients who underwent single-photon emission computed tomography MPI for suspected CAD between January 2015 and December 2021 were identified. Multivariable Cox regression modeling was used to assess the associations between medical therapy and all-cause mortality.

Results

In total, 7802 patients were included with a mean age of 66.1 ± 12.0 years and 3841 (49.2 %) male patients. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE inhibitors/ARBs) were associated with lower mortality (adjusted hazard ratio [HR] .66, 95 % confidence interval [CI]: .57-.77, P < .001). Beta-blockers were not associated with mortality overall (adjusted HR .95, 95 % CI: .83-1.10, P = .506) but were associated with lower mortality among patients with more ischemia (HR .94 per summed difference score point, 95 % CI: .90-.97, P-value <.001). Statins were associated with greater survival in patients with coronary calcium (adjusted HR .67, 95 % CI .56-.81, P = <0.001) but not in patients without assessment of coronary calcium (adjusted HR: 1.16, 95 % CI: .91–1.49 P = .236).

Conclusion

ACE/ARB prescription was significantly associated with improved survival. Beta-blocker prescription was associated with greater survival in patients with ischemia and statins were in patients with coronary calcification. Findings from MPI may identify patients more likely to benefit from specific therapies, suggesting a role for hybrid MPI in guiding medical therapy for CAD.

Abstract Image

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根据SPECT MPI的发现，药物治疗与生存的关系。

背景：心肌灌注成像（MPI）可导致药物处方的下游变化。虽然药物治疗对冠状动脉疾病（CAD）的益处是确定的，但这与MPI结果的差异是未知的。我们的目的是评估药物治疗与MPI患者生存的关系，包括影像学表现的差异关系。方法：选取2015年1月至2021年12月期间连续接受SPECT MPI诊断疑似CAD的患者。多变量Cox回归模型用于评估药物治疗与全因死亡率之间的关系。结果：共纳入7802例患者，平均年龄（66.1±12.0）岁，男性3841例（49.2%）。血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACE/ARB）与较低的死亡率相关（校正风险比[HR] 0.79, 95% CI 0.69-0.89, p）结论：ACE/ARB处方与改善生存率显著相关。β受体阻滞剂处方与缺血患者的更高生存率相关，他汀类药物适用于冠状动脉钙化患者。MPI的发现可以识别更有可能从特定治疗中获益的患者，这表明混合MPI在指导CAD医学治疗方面的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Nuclear Cardiology 医学-核医学

CiteScore

5.30

自引率

20.80%

发文量

249

审稿时长

4-8 weeks

期刊介绍： Journal of Nuclear Cardiology is the only journal in the world devoted to this dynamic and growing subspecialty. Physicians and technologists value the Journal not only for its peer-reviewed articles, but also for its timely discussions about the current and future role of nuclear cardiology. Original articles address all aspects of nuclear cardiology, including interpretation, diagnosis, imaging equipment, and use of radiopharmaceuticals. As the official publication of the American Society of Nuclear Cardiology, the Journal also brings readers the latest information emerging from the Society''s task forces and publishes guidelines and position papers as they are adopted.