AIMS The role of revascularization in chronic coronary syndrome (CCS) and the value of ischaemia vs. anatomy to guide decision-making are in constant debate. We explored the potential of a combined assessment of ischaemic burden by vasodilator stress cardiovascular magnetic resonance (CMR) and presence of multivessel disease by angiography to predict the effect of revascularization on all-cause mortality in CCS. METHODS AND RESULTS The study group comprised 1066 CCS patients submitted to vasodilator stress CMR pre-cardiac catheterization (mean age 66 ± 11 years, 69% male). Stress CMR-derived ischaemic burden (extensive if >5 ischaemic segments) and presence of multivessel disease in angiography (two- or three-vessel or left main stem disease) were computed. The influence of revascularization on all-cause mortality was explored and adjusted hazard ratios (HRs) with the corresponding 95% confidence intervals were obtained. During a median 7.51-year follow-up, 557 (52%) CMR-related revascularizations and 308 (29%) deaths were documented. Revascularization exerted a neutral effect on all-cause mortality in the whole study group [HR 0.94 (0.74-1.19), P = 0.6], in patients without multivessel disease [n = 598, 56%, HR 1.12 (0.77-1.62), P = 0.6], and in those with multivessel disease without extensive ischaemic burden [n = 181, 17%, HR 1.66 (0.91-3.04), P = 0.1]. However, compared to non-revascularized patients, revascularization significantly reduced all-cause mortality in patients with simultaneous multivessel disease and extensive ischaemic burden (n = 287, 27%): 3.77 vs. 7.37 deaths per 100 person-years, HR 0.60 (0.40-0.90), P = 0.01. CONCLUSIONS In patients with CCS submitted to catheterization, evidence of simultaneous extensive CMR-related ischaemic burden and multivessel disease identifies the subset in whom revascularization can reduce all-cause mortality.

中文翻译：

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联合评估负荷心血管磁共振和血管造影以预测慢性冠状动脉综合征患者血运重建的效果。

目的 血运重建在慢性冠状动脉综合征 (CCS) 中的作用以及缺血与解剖学在指导决策中的价值一直存在争议。我们探索了通过血管扩张剂应激心血管磁共振 (CMR) 联合评估缺血负荷和通过血管造影术评估多支血管疾病的可能性，以预测血运重建对 CCS 全因死亡率的影响。方法和结果 研究组包括 1066 名接受血管扩张剂负荷 CMR 心导管术前的 CCS 患者（平均年龄 66 ± 11 岁，69% 为男性）。计算应力 CMR 衍生的缺血负荷（如果 >5 个缺血节段则为广泛）和血管造影中存在多支血管疾病（两支或三支血管或左主干疾病）。探讨了血运重建对全因死亡率的影响，并获得了具有相应 95% 置信区间的调整风险比 (HR)。在中位 7.51 年的随访期间，记录了 557 例（52%）与 CMR 相关的血运重建和 308 例（29%）死亡。血运重建对整个研究组的全因死亡率产生中性影响 [HR 0.94 (0.74-1.19), P = 0.6]，在没有多支血管疾病的患者 [n = 598, 56%, HR 1.12 (0.77-1.62), P = 0.6]，在没有广泛缺血负担的多支血管疾病患者中 [n = 181, 17%, HR 1.66 (0.91-3.04), P = 0.1]。然而，与未接受血运重建的患者相比，血运重建显着降低了同时患有多支血管疾病和广泛缺血负荷的患者的全因死亡率（n = 287, 27%）：3.77 vs. 7。每 100 人年有 37 人死亡，HR 0.60 (0.40-0.90)，P = 0.01。结论 在接受导管插入术的 CCS 患者中，同时存在广泛的 CMR 相关缺血负荷和多支血管疾病的证据确定了血运重建可以降低全因死亡率的亚组。