Peri-infarct ischaemia predicts adverse cardiac events

Peri-infarct ischaemia, detected by stress cardiac magnetic imaging, is significantly associated with adverse cardiovascular events, a study has shown.

Of the 3,915 patients (mean age 61.0 years, 54.7 percent male) included in this analysis, 752 (19.2 percent) had ischaemia, 1,123 (28.8 percent) had infarct, and 382 (9.8 percent) had peri-infarct ischaemia.

Primary outcome events (ie, acute myocardial infarction and cardiovascular death) occurred in 406 (10.4 percent) patients and secondary events (ie, any primary events, hospitalization for unstable angina, heart failure hospitalization, and late coronary artery bypass surgery) in 745 (19.0 percent) at 5.3 years of median follow-up.

The presence of peri-infarct ischaemia was strongly predictive of primary (adjusted hazard ratio [aHR], 1.72, 95 percent confidence interval [CI], 1.23‒2.41) and secondary events (HR, 1.71, 95 percent CI, 1.32‒2.20; p<0.001 for both), with adjustments for clinical risk factors, left ventricular function, ischaemia extent, and infarct size.

Specifically, peri-infarct ischaemia presence was associated with a more than sixfold increase in annualized primary event rate relative to no infarct and ischaemia (6.5 percent vs 0.9 percent).

This analysis involving consecutive patients in an expanded cohort of the multicentre SPINS study examined whether peri-infarct ischaemia correlated with adverse events incremental to known risk markers. Peri-infarct ischaemia referred to the presence of any ischaemic segment neighbouring an infarcted segment by late gadolinium enhancement imaging.

“Early invasive revascularization guided by moderate to severe ischaemia did not improve outcomes over medical therapy alone, underlying the need to identify high-risk patients for a more effective invasive referral,” the authors said.