Patient-specific registries of fractional risk and survival are a viable strategy to identify patients with ischemic cardiomyopathy (ICM) who would benefit from early revascularization. According to recent research Published in JACC: Cardiovascular image processing.

Dr. Jacob Abudayemstudied 941 patients with ICM (mean age 65 years, 81% male) who underwent cardiac magnetic resonance (CMR) and invasive coronary angiography between 2015 and 2022. The authors estimated the risk of segmental perfusion from the patient-specific vascular tree and determined the at-risk but viable segment by considering the segmental survival score.

Overall, 193 patients underwent early revascularization, and 168 died during a median follow-up of 4.8 years. Patients with three or more at-risk but viable segments had significantly lower mortality after early revascularization (propensity score adjusted hazard ratio: 0.55; p=0.015).

“Consistent with previous studies, survivability alone and overall measures [coronary artery disease] The authors wrote, “Burden alone did not alter the relationship between revascularization and mortality. Therefore, partial registration of patient-specific coronary anatomy and myocardial survival appears to be an important factor in estimating the benefit of revascularization in patients with ICM.”

in Accompanying editorial comments, Robert S. Chan, MD, BA, FACCand Jonathan W. Weinsaft, MD, FACC“This paper provides valuable insights and demonstrates a viable and meaningful integrated anatomical/functional imaging approach…The approach used to determine myocardium at risk leveraged primary CMR and invasive angiographic approaches that are widely available in daily clinical practice, increasing generalizability.”