Myocardial Viability and Survival in Ischemic Left Ventricular Dysfunction
By R. Bonow, G. Maurer, Kerry L Lee, T. Holly, P. Binkley, P. Desvigne‐Nickens, J. Drożdż, P. Farsky, A. Feldman, T. Doenst and 12 more. New England Journal of Medicine, 2011
808 citations recorded by the source corpus.
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 pre-specified 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. (Funded by the National Heart, Lung, and Blood Institute; STICH ClinicalTrials.gov number, NCT00023595.)
Subfields: Radiology, Nuclear Medicine and Imaging, Surgery
View Paper: https://www.semanticscholar.org/paper/138c78f2779ea46a19766961471ca08bf92fd150
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Citations in the corpus
- 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. (2013, result): “Although the results of the STICH (Surgical Treatment for Ischemic Heart Failure) trial have cast doubt on the role of myocardial viability assessment to determine the mode of therapy (304), the data are nevertheless predictive of a positive outcome.”
- 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesi (2011, result): “Although the primary outcome (death from any cause) was similar in the 2 treatment groups after an average of 5 years of follow-up, the data suggest the possibility that outcomes would differ if the follow-up were longer in duration; as a result, the study is being continued to provide follow-up for”
- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2016, neutral): “In the STICH trial, neither the presence of viability nor the severity of LV remodelling identified those who benefited from CABG in terms of a reduction in mortality.(118) For the assessment of techniques to assess myocardial viability, please refer to Section 5.”
- 2018 ESC/EACTS Guidelines on myocardial revascularization. (2019, neutral): “The viability substudy of the STICH (Surgical Treatment for Ischemic Heart Failure) trial found viable myocardium in 487/601 patients (81%) and none in 114 (19%).(9) There was a significant association between myocardial viability and outcome by univariate analysis, but not on multivariable analysis”