OUTCOME OF MEDICAL VERSUS INVASIVE TREATMENT STRATEGIES FOR NON-HIGH-RISK ISCHEMIC-HEART-DISEASE

The purpose of this study was to evaluate the outcomes of medical mana gement compared with invasive management for patients with mild or mod erate ischemia (non-high-risk) on stress tomographic myocardial perfus ion scintigraphy, Of the 1,352 non-high-risk patients, 116 (9%) subseq uently were referred for coronary angiography within the first 30 days after the scan; 99 (85%) of this group also underwent early revascula rization procedures, The remaining 1,236 patients (91%) with non-high- risk ischemia did not undergo early invasive management, Unadjusted ac tuarial 3-year rate of cardiac death or nonfatal infarction was signif icantly better estimated survival in the medically managed group (2%) compared with the invasively managed group (22%), p = 0.0001, Subseque nt coronary revascularization procedures during 3-year follow-up were less frequent in the medically managed group (4%) than in the invasive ly managed group (42%), p = 0.0001, A multivariable analysis identifie d invasive management strategy (p = 0.0001) as the only correlate of c ardiac events during follow-up, In summary, this study showed that pat ients with non-high-risk ischemia on stress perfusion imaging can be t reated safely with a conservative medical management strategy.