The value of undertaking early myocardial revascularization in patients with inducible myocardial ischemia and poor left ventricular ejection fraction (LVEF) is uncertain at the time. For a study, researchers sought to determine if there was a link between stress-induced myocardial ischemia, revascularization, and all-cause mortality (ACM) in patients with normal vs. low LVEF.

From 1998 to 2017, they studied 43,443 patients who underwent stress-rest single-photon emission computed tomography myocardial perfusion imaging. The average length of follow-up was 11.4 years. Myocardial ischemia was studied to see how it affected early revascularization and death. To correct for nonrandomization to revascularization, a propensity score was utilized, followed by multivariable Cox modeling adjusted for the propensity score and clinical factors to predict ACM.

According to LVEF and angina, the incidence of myocardial ischemia differed significantly, from 6.7% among patients with LVEF ≥55% and no typical angina to 64.0% among patients with LVEF <45% and typical angina (P<0.001). Early revascularization was linked to higher mortality risk among patients without ischemia and decreased mortality risk among those with severe (≥15%) ischemia among 39,883 patients with LVEF ≥45% (HR: 0.70; 95% CI: 0.52-0.95). Revascularization was not linked with lower mortality among 3,560 patients with LVEF <45% who had minimal or mild ischemia, but it was associated with decreased mortality among those who had moderate (10%–14%) (HR: 0.67; 95% CI: 0.49–0.91) and severe (≥15%) (HR: 0.55; 95% CI: 0.38-0.80) ischemia.

Both patients with normal LVEF and severe inducible myocardial ischemia and those with low LVEF and moderate or severe inducible myocardial ischemia saw a significant reduction in mortality when early myocardial revascularization was carried out within the group.

Reference: jacc.org/doi/10.1016/j.jacc.2022.04.052