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 management compared with invasive management for patients with mild or moderate ischemia (non-high-risk) on stress tomographic myocardial perfusion scintigraphy. Of the 1,352 non-high-risk patients, 116 (9%) subsequently were referred for coronary angiography within the first 30 days after the scan; 99 (85%) of this group also underwent early revascularization procedures. The remaining 1,236 patients (91%) with non-high-risk ischemia did not undergo early invasive management. Unadjusted actuarial 3-year rate of cardiac death or nonfatal infarction was significantly better estimated survival in the medically managed group (2%) compared with the invasively managed group (22%), p = 0.0001. Subsequent coronary revascularization procedures during 3-year follow-up were less frequent in the medically managed group (4%) than in the invasively managed group (42%), p = 0.0001. A multivariable analysis identified invasive management strategy (p = 0.0001) as the only correlate of cardiac events during follow-up. In summary, this study showed that patients with non-high-risk ischemia on stress perfusion imaging can be treated safely with a conservative medical management strategy.