CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

January 21st, 2014

Anatomical Burden in CAD Predicts Outcome Better Than Ischemic Burden

In stable coronary artery disease (CAD), anatomical burden (the degree of occlusion found on angiography) and left-ventricular ejection fraction seem better predictors of outcome than either ischemic burden (as measured during stress CT) or initial treatment with medical therapy alone or added PCI.

In a substudy of the COURAGE trial, 621 patients underwent both anatomical and ischemic studies. Half received optimal medical therapy initially, and half received medical therapy plus PCI.

During a mean 5 years’ follow-up, the composite outcome (death, MI, or non-ST-segment elevation acute coronary syndrome) was better predicted by anatomic burden and ejection fraction than by ischemic burden. However none of the measures — alone or in combination — identified a group that would have benefited from early PCI.

Writing in the Journal of the American College of Cardiology: Cardiovascular Interventions, an editorialist speculates that greater anatomical burden may signal the presence of more plaques that could cause later events, whereas established ischemic burden would not be as predictive. He also points out that the ongoing ISCHEMIA study may further clarify the best approach in these patients.

Adapted from Physician’s First Watch

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