TY - JOUR
T1 - Myocardial viability and survival in ischemic left ventricular dysfunction
AU - Bonow, Robert O.
AU - Maurer, Gerald
AU - Lee, Kerry L.
AU - Holly, Thomas A.
AU - Binkley, Philip F.
AU - Desvigne-Nickens, Patrice
AU - Drozdz, Jaroslaw
AU - Farsky, Pedro S.
AU - Feldman, Arthur M.
AU - Doenst, Torsten
AU - Michler, Robert E.
AU - Berman, Daniel S.
AU - Nicolau, Jose C.
AU - Pellikka, Patricia A.
AU - Wrobel, Krzysztof
AU - Alotti, Nasri
AU - Asch, Federico M.
AU - Favaloro, Liliana E.
AU - She, Lilin
AU - Velazquez, Eric J.
AU - Jones, Robert H.
AU - Panza, Julio A.
PY - 2011/4/28
Y1 - 2011/4/28
N2 - Background: The assessment of myocardial viability has been used to identify patients with coronary artery disease and left ventricular dysfunction in whom coronary-artery bypass grafting (CABG) will provide a survival benefit. However, the efficacy of this approach is uncertain. methods: In a substudy of patients with coronary artery disease and left ventricular dysfunction who were enrolled in a randomized trial of medical therapy with or without CABG, we used single-photon-emission computed tomography (SPECT), dobutamine echocardiography, or both to assess myocardial viability on the basis of prespecified thresholds. results: Among the 1212 patients enrolled in the randomized trial, 601 underwent assessment of myocardial viability. Of these patients, we randomly assigned 298 to receive medical therapy plus CABG and 303 to receive medical therapy alone. A total of 178 of 487 patients with viable myocardium (37%) and 58 of 114 patients without viable myocardium (51%) died (hazard ratio for death among patients with viable myocardium, 0.64; 95% confidence interval [CI], 0.48 to 0.86; P = 0.003). However, after adjustment for other baseline variables, this association with mortality was not significant (P=0.21). There was no significant interaction between viability status and treatment assignment with respect to mortality (P = 0.53). conclusions: The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables. The assessment of myocardial viability did not identify patients with a differential survival benefit from CABG, as compared with medical therapy alone.
AB - Background: The assessment of myocardial viability has been used to identify patients with coronary artery disease and left ventricular dysfunction in whom coronary-artery bypass grafting (CABG) will provide a survival benefit. However, the efficacy of this approach is uncertain. methods: In a substudy of patients with coronary artery disease and left ventricular dysfunction who were enrolled in a randomized trial of medical therapy with or without CABG, we used single-photon-emission computed tomography (SPECT), dobutamine echocardiography, or both to assess myocardial viability on the basis of prespecified thresholds. results: Among the 1212 patients enrolled in the randomized trial, 601 underwent assessment of myocardial viability. Of these patients, we randomly assigned 298 to receive medical therapy plus CABG and 303 to receive medical therapy alone. A total of 178 of 487 patients with viable myocardium (37%) and 58 of 114 patients without viable myocardium (51%) died (hazard ratio for death among patients with viable myocardium, 0.64; 95% confidence interval [CI], 0.48 to 0.86; P = 0.003). However, after adjustment for other baseline variables, this association with mortality was not significant (P=0.21). There was no significant interaction between viability status and treatment assignment with respect to mortality (P = 0.53). conclusions: The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables. The assessment of myocardial viability did not identify patients with a differential survival benefit from CABG, as compared with medical therapy alone.
UR - http://www.scopus.com/inward/record.url?scp=79955486739&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79955486739&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa1100358
DO - 10.1056/NEJMoa1100358
M3 - Article
C2 - 21463153
AN - SCOPUS:79955486739
SN - 0028-4793
VL - 364
SP - 1617
EP - 1625
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 17
ER -