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Myocardial viability and survival in ischemic left ventricular dysfunction.

Publication ,  Journal Article
Bonow, RO; Maurer, G; Lee, KL; Holly, TA; Binkley, PF; Desvigne-Nickens, P; Drozdz, J; Farsky, PS; Feldman, AM; Doenst, T; Michler, RE; She, L ...
Published in: N Engl J Med
April 28, 2011

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. (Funded by the National Heart, Lung, and Blood Institute; STICH ClinicalTrials.gov number, NCT00023595.).

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Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

April 28, 2011

Volume

364

Issue

17

Start / End Page

1617 / 1625

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Tomography, Emission-Computed, Single-Photon
  • Statistics, Nonparametric
  • Proportional Hazards Models
  • Myocardium
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
 

Citation

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Bonow, R. O., Maurer, G., Lee, K. L., Holly, T. A., Binkley, P. F., Desvigne-Nickens, P., … STICH Trial Investigators, . (2011). Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med, 364(17), 1617–1625. https://doi.org/10.1056/NEJMoa1100358
Bonow, Robert O., Gerald Maurer, Kerry L. Lee, Thomas A. Holly, Philip F. Binkley, Patrice Desvigne-Nickens, Jaroslaw Drozdz, et al. “Myocardial viability and survival in ischemic left ventricular dysfunction.N Engl J Med 364, no. 17 (April 28, 2011): 1617–25. https://doi.org/10.1056/NEJMoa1100358.
Bonow RO, Maurer G, Lee KL, Holly TA, Binkley PF, Desvigne-Nickens P, et al. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med. 2011 Apr 28;364(17):1617–25.
Bonow, Robert O., et al. “Myocardial viability and survival in ischemic left ventricular dysfunction.N Engl J Med, vol. 364, no. 17, Apr. 2011, pp. 1617–25. Pubmed, doi:10.1056/NEJMoa1100358.
Bonow RO, Maurer G, Lee KL, Holly TA, Binkley PF, Desvigne-Nickens P, Drozdz J, Farsky PS, Feldman AM, Doenst T, Michler RE, Berman DS, Nicolau JC, Pellikka PA, Wrobel K, Alotti N, Asch FM, Favaloro LE, She L, Velazquez EJ, Jones RH, Panza JA, STICH Trial Investigators. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med. 2011 Apr 28;364(17):1617–1625.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

April 28, 2011

Volume

364

Issue

17

Start / End Page

1617 / 1625

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Tomography, Emission-Computed, Single-Photon
  • Statistics, Nonparametric
  • Proportional Hazards Models
  • Myocardium
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans