An Initial Strategy of Intensive Medical Therapy Is Comparable to That of Coronary Revascularization for Suppression of Scintigraphic Ischemia in High-Risk But Stable Survivors of Acute Myocardial Infarction
John J. Mahmarian, MD*,*,
Habib A. Dakik, MD ,
Neil G. Filipchuk, MD ,
Leslee J. Shaw, PhD ,
Sherif S. Iskander, MD||,
Terrence D. Ruddy, MD¶,
Felix Keng, MD#,
Milena J. Henzlova, MD**,
Adel Allam, MD,
Lemuel A. Moyé, MD, PhD,
Craig M. Pratt, MD* for the INSPIRE Investigators
* Methodist DeBakey Heart Center, Department of Cardiology, The Methodist Hospital, Houston, Texas USA
American University of Beirut, Beirut, Lebanon
University of Calgary, Calgary, Alberta, Canada
Cedars-Sinai Medical Center, Los Angeles, California USA
|| Cardiovascular Associates of East Texas, Tyler, Texas USA
¶ University of Ottawa Heart Institute, Ottawa, Ontario, Canada
# National Heart Centre, Singapore, Singapore
** Mount Sinai Medical Center, New York, New York USA
Al-Azhar University, Cairo, Egypt
University of Texas School of Public Health, Houston, Texas USA
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Figure 1 Absolute mean (± SD) change in scintigraphic variables in 169 randomized patients who had 2 adenosine single-photon tomographic (SPECT) studies. LV = left ventricle; LVEF = left ventricular ejection fraction; PDS = perfusion defect size.
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Figure 2 Primary end point: absolute mean (± SD) and individual changes in total and ischemic left ventricular (LV) perfusion defect size (PDS) from SPECT-1 to SPECT-2 study in the 2 randomized groups. The dashed line represents a 9% reduction in PDS (i.e., 95% confidence interval for a real patient change). Other abbreviations as in Figure 1.
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Figure 3 Serial SPECT images and polar plot of a patient randomized to medical therapy. Baseline SPECT (A) shows a large perfusion defect (arrows) in the short (SA), horizontal long (HLA), and vertical long (VLA) axis slices after stress (upper panels) which improves with rest imaging (lower panels). Ischemia is present in the right and circumflex vascular territories. Total LV PDS is 30% with 25% ischemia (green) and 5% scar (black). The patient was treated with a beta-blocker, calcium-channel blocker, and statin. Repeat SPECT (B) is entirely normal. This patient had no subsequent cardiac event. Other abbreviations as in Figure 1.
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