Myocardial viability and long-term outcomes in ischemic cardiomyopathy
N. Engl. j. med
; 381(8): 739-748, ago., 2019. graf., tab.
Article
in English
| Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1022569
Responsible library:
BR79.1
Localization: BR79.1
ABSTRACT
BACKGROUND:
The role of assessment of myocardial viability in identifying patients with ischemic cardiomyopathy who might benefit from surgical revascularization remains controversial. Furthermore, although improvement in left ventricular function is one of the goals of revascularization, its relationship to subsequent outcomes is unclear.METHODS:
Among 601 patients who had coronary artery disease that was amenable to coronaryartery bypass grafting (CABG) and who had a left ventricular ejection fraction of 35% or lower, we prospectively assessed myocardial viability using single-photonemission computed tomography, dobutamine echocardiography, or both. Patients were randomly assigned to undergo CABG and receive medical therapy or to receive medical therapy alone. Left ventricular ejection fraction was measured at baseline and after 4 months of follow-up in 318 patients. The primary end point was death from any cause. The median duration of follow-up was 10.4 years.RESULTS:
CABG 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. 209 deaths among 303 patients in the medical-therapy group; adjusted hazard ratio, 0.73; 95% confidence interval, 0.60 to 0.90). 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). An increase in left ventricular ejection fraction was observed only among patients with myocardial viability, irrespective of treatment assignment. There was no association between changes in left ventricular ejection fraction and subsequent death.CONCLUSIONS:
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. 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. (Funded by the National Institutes of Health; STICH ClinicalTrials.gov number, NCT00023595.). (AU)
Full text:
Available
Collection:
National databases
/
Brazil
Health context:
SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases
Health problem:
Cardiovascular Disease
/
Other circulatory Diseases
Database:
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Main subject:
Coronary Artery Bypass
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Prospective Studies
/
Echocardiography, Stress
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Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
Type of study:
Observational study
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Prognostic study
/
Risk factors
Limits:
Female
/
Humans
/
Male
Language:
English
Journal:
N. Engl. j. med
Year:
2019
Document type:
Article
Institution/Affiliation country:
Cedars Sinai Medical Center/US
/
Duke Clinical Research Institute/US
/
Instituto Dante Pazzanese de Cardiologia/BR
/
Mayo Clinic/US
/
MedStar Washington Hospital Center/US
/
Medical University of Lodz/PL
/
Medical University of Vienna/AT
/
Montreal Heart Institute/CA
/
National Heart Center Singapore/MY
/
Northwestern University/US