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PCI may reduce risk for death, MI in silent ischemia

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Stephane Fournier

MUNICH — Patients with silent ischemia who underwent PCI had a lower rate of death or MI compared with those who received medical therapy alone, according to data presented at the European Society of Cardiology Congress.

In a post-hoc analysis of data from the FAME 2 trial, Stephane Fournier, MD, clinical fellow at Cardiovascular Center Aalst at OLV Hospital Aalst in Belgium, and colleagues analyzed data from 888 patients with at least one significant stenosis as determined by fractional flow reserve. Patients were assigned PCI with medical therapy or medical therapy alone.

The outcomes of interest were assessed at 5 years and included MACE, defined as all-cause death, MI and urgent revascularization, in addition to death or MI, nonurgent revascularization and any revascularization.

Of the overall population, 98 patients (mean age, 66 years; 85% men) had silent ischemia vs. 789 patients who were symptomatic (mean age, 63 years; 77% men). More patients who were symptomatic had hyperlipidemia more often compared with those with silent ischemia (79% vs. 66%; P = .006), and those in the silent ischemia group were more likely to have peripheral vascular disease (22% vs. 9%; P < .001) and renal failure (9% vs. 2%; P < .001).

In patients assigned medical therapy alone, the rate of the primary endpoint of mortality, MI and urgent revascularization was similar in patients with silent ischemia and those who were symptomatic. Patients with silent ischemia had higher rates of MI vs. those who were symptomatic (24% vs. 11%; adjusted HR = 2.67; 95% CI, 1.35-5.38). These patients also had higher rates of death or MI (31% vs. 14%; adjusted HR = 2.16; 95% CI, 1.18-3.97).

“We observe indeed that the differences get even higher and higher across the time,” Fournier said during the presentation.

The symptomatic group had higher rates of nonurgent revascularization compared with the silent ischemia group (37% vs. 18%; HR = 0.43; 95% CI, 0.24-0.7).

“The higher your symptomatic class at randomization, the higher the proportion of nonurgent revascularization,” Fournier said.

Contrariwise, among patients assigned to PCI, the rate of death or MI was comparable between patients with silent ischemia and patient with symptoms.

Finally, patients with silent ischemia assigned PCI had a significant benefit regarding death or MI compared with those assigned medical therapy alone (9.4% vs. 31.1%; HR = 0.236; 95% CI, 0.08-0.66).

“In stable patients with silent ischemia, the rate of death or MI is more than twice as high, but the rate of revascularization is more than twice as low as compared to patients with symptomatic ischemia,” Fournier said. “In stable patients with silent ischemia, PCI reduces the rate of death or MI as compared to medical therapy alone.” – by Darlene Dobkowski

Reference:

Fournier S, et al. Late-Breaking Science in Interventional Cardiology 2. Presented at: European Society of Cardiology Congress; Aug. 25-29, 2018; Munich.

Disclosure: Fournier reports no relevant financial disclosures.