Ischemic heart disease is the most common and most lethal cause of heart failure. (Funded by the National Institutes of Health STICH number, NCT00023595.) Introduction The presence of viable myocardium was associated with improvement in left ventricular systolic function, irrespective of treatment, but such improvement was not related to long-term survival. The findings of this study do not support the concept that myocardial viability is associated with a long-term benefit of CABG in patients with ischemic cardiomyopathy. There was no association between changes in left ventricular ejection fraction and subsequent death. An increase in left ventricular ejection fraction was observed only among patients with myocardial viability, irrespective of treatment assignment.
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However, no significant interaction was observed between the presence or absence of myocardial viability and the beneficial effect of CABG plus medical therapy over medical therapy alone (P=0.34 for interaction). 209 deaths among 303 patients in the medical-therapy group adjusted hazard ratio, 0.73 95% confidence interval, 0.60 to 0.90). ResultsĬABG plus medical therapy was associated with a lower incidence of death from any cause than medical therapy alone (182 deaths among 298 patients in the CABG group vs. The median duration of follow-up was 10.4 years. The primary end point was death from any cause. Left ventricular ejection fraction was measured at baseline and after 4 months of follow-up in 318 patients. Patients were randomly assigned to undergo CABG and receive medical therapy or to receive medical therapy alone. MethodsĪmong 601 patients who had coronary artery disease that was amenable to coronary-artery bypass grafting (CABG) and who had a left ventricular ejection fraction of 35% or lower, we prospectively assessed myocardial viability using single-photon-emission computed tomography, dobutamine echocardiography, or both. Furthermore, although improvement in left ventricular function is one of the goals of revascularization, its relationship to subsequent outcomes is unclear. The role of assessment of myocardial viability in identifying patients with ischemic cardiomyopathy who might benefit from surgical revascularization remains controversial. The most trusted, influential source of new medical knowledge and clinical best practices in the world.
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