The following is the summary of “Cardiovascular events in patients with coronary artery disease with and without myocardial ischemia: Long-term follow-up” published in the February 2023 issue of Heart by Carvalho, et al.

Myocardial ischemia’s impact on the prognosis of coronary artery disease (CAD) prognosis was controversial following the ISCHEMIA Trial’s findings. Researchers aimed to compare the long-term outcomes of patients with and without confirmed myocardial ischemia who were diagnosed with multivessel CAD. For this retrospective, observational cohort study, patients with CAD were retrieved from the research protocols database of “The Medicine, Angioplasty, or Surgery Analysis,” the MASS Study Group. Myocardial ischemia status was used to divide patients into different groups. After entering their information into the registry, participants were followed for an average of 8.7 years to see if any cardiovascular events (including death or a heart attack) had occurred. 

A functional test, with or without imaging, was used to determine the presence of myocardial ischemia at baseline. In addition, 2015 patients with multi-vessel CAD from 1995-2018 were included. At the time of their registry inclusion, 1001 patients had definitive test results, with 790 (79%) showing signs of ischemia and 211 (21% showing no signs of ischemia. An average of 8.7 years was spent following up with patients (IQR 4.04 to 10.07). It was shown that 228 patients (28.9%) with ischemia experienced the primary result, while 64 patients (30.3%) without ischemia did not (plog-rank=0.60). 

It was found that the presence of myocardial ischemia and treatment techniques did not significantly interact with the occurrence of the combined primary outcome (pinteration=0.14). Patients with multivessel CAD who had myocardial ischemia did not have a worse outcome than those who did not. These findings are relevant to discussions about the impact of myocardial ischemia on the occurrence of cardiovascular events.