The definition, presentation, and management of myocardial infarction (MI) have changed
substantially in the last decade. Whether these changes have impacted on the presence,
severity, and localization of necrosis at myocardial perfusion imaging (MPI) has not
been appraised to date. Subjects undergoing MPI and reporting a history of clinical
MI were shortlisted. We focused on the presence, severity, and localization of necrosis
at MPI with a retrospective single-center analysis. A total of 10,476 patients were
included, distinguishing 5 groups according to the period in which myocardial perfusion
scintigraphy had been performed (2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to
2011, 2012 to 2013). Trend analysis showed over time a significant worsening in baseline
features (e.g., age, diabetes mellitus, and Q waves at electrocardiogram), whereas
medical therapy and revascularization were offered with increasing frequency. Over
the years, there was also a lower prevalence of normal MPI (from 16.8% to 13.6%) and
ischemic MPI (from 35.6% to 32.8%), and a higher prevalence of ischemic and necrotic
MPI (from 12.0% to 12.7%) or solely necrotic MPI (from 35.7% to 40.9%, p <0.001).
Yet the prevalence of severe ischemia decreased over time from 11.4% to 2.0%, with
a similar trend for moderate ischemia (from 15.9% to 11.8%, p <0.001). Similarly sobering
results were wound for the prevalence of severe necrosis (from 19.8% to 8.2%) and
moderate necrosis (from 8.5% to 7.8%, p = 0.028). These trends were largely confirmed
at regional level and after propensity score matching. In conclusion, the outlook
of stable patients with previous MI has substantially improved in the last decade,
with a decrease in the severity of residual myocardial ischemia and necrosis, despite
an apparent worsening in baseline features.
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Article Info
Publication History
Published online: August 22, 2017
Accepted:
July 6,
2017
Received:
April 19,
2017
Footnotes
This study was supported by ETISAN , Rome, Italy.
See page 1244 for disclosure information.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
