English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

In stable coronary artery disease (CAD), one of the key questions in clinical practice is whether and when a patient needs invasive study and revascularization such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting surgery (CABG). Currently, there are two major therapeutic strategies for stable CAD; the invasive strategy including early coronary angiography (CAG) and subsequent revascularization if indicated, and the non-invasive strategy including optimal medical therapy (OMT). In both the strategies, there have been major advances in the last few decades including the use of drug-eluting stent for PCI and addition of statins in OMT. However, the basic principle of selecting treatment option in stable CAD has not been changed; to reduce futile invasive CAG and revascularization using non-invasive studies for selecting high-risk patients. Myocardial perfusion imaging (MPI) using singlephoton emission computed tomography (SPECT) or positron emission tomography (PET) has been used in stable CAD for selecting high-risk patients who require revascularization. In a milestone study by Hachamovitch et al., it was reported that revascularization is more beneficial than OMT in patients who showed moderate to large amounts of inducible ischemia on SPECT. However, there have been some conflicting results. For example, in the nuclear substudy of the COURAGE trial, it was reported that the extent of ischemia on MPI was not predictive of adverse events and did not affect treatment effectiveness. Despite these conflicting results, there have been hundreds of reports on the prognostic role of MPI in CAD, which were summarized in several review articles. Additionally, there have been other studies that demonstrated effectiveness of MPI in selecting treatment options. In an observation study that followed up 13,969 patients for more than 7 years, early revascularization was beneficial in patients who exhibited significant ischemia without extensive scar on SPECT, whereas OMT was superior to revascularization in patients with minimal ischemia. In another study that used MPI PET, coronary flow reserve (CFR) measured on PET was an independent factor from CAG in modifying the effectiveness of early CABG or PCI. In the current issue of Journal of Nuclear Cardiology, Boiten et al. reported treatment effectiveness according to MPI SPECT findings. They followed up 702 patients who exhibited ischemia on SPECT for a median of 12 years, and observed that early revascularization was more beneficial than OMT in this group. Additionally, prognosis was associated with the extent of ischemia on SPECT. Although the study has some limitations of retrospective design, enrollment of only patients with ischemia, and treatment based on relatively old methods like bare metal stent or old drug regimens, it demonstrated again the effectiveness of MPI in selecting high-risk patients who require revascularization. MPI-based decision of invasive treatment is still a valid strategy. Another option of non-invasive imaging method in CAD is coronary computed tomography angiography (CCTA). Because CCTA targets for anatomical stenosis that is also the diagnostic target in CAG, it has high diagnostic performance for CAG-confirmed CAD. Thus, CCTA can be effectively used for determining the need for CAG; in the SCOT-HEART trial in which 4146 patients were randomly assigned to standard care group or standard care plus CCTA group, CCTA led to more Reprint requests: Dong Soo Lee, MD, Department of Nuclear Medicine, University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea; dsl@snu.ac.kr J Nucl Cardiol 2018;25:967–9. 1071-3581/$34.00 Copyright 2016 American Society of Nuclear Cardiology.

Screening high-risk patients and selecting treatment options in stable coronary artery disease using myocardial perfusion imaging