Transcript CABG
Myocardial Viability and Survival in Ischemic Left Ventricular Dysfunction Robert O. Bonow, M.D., Gerald Maurer, M.D., Kerry L. Lee, Ph.D., Thomas A. Holly, M.D., Philip F. Binkley, M.D., Patrice Desvigne-Nickens, M.D., Jaroslaw Drozdz, M.D., Ph.D., Pedro S. Farsky, M.D., Arthur M. Feldman, M.D., N Engl J Med 2011;364:1617-25 R2 Kang Sung-wook / prof. Kim woo-sik Background Coronary artery disease Important contributor to the rise in the prevalence of heart failure and in associated mortality and morbidity Coronary-artery bypass grafting (CABG) Improving the symptoms and the rate of survival of patients with coronary artery disease and heart failure? Not clearly established Surgical Treatment for Ischemic Heart Failure (STICH) trial Compared the efficacy of medical therapy alone with that of medical therapy plus CABG Background The assessment of myocardial viability Single-photon-emission computed tomography (SPECT) Low-dose dobutamine echocardiography To predict improvement in left ventricular function after CABG Report Outcome of patients who were randomly assigned to receive medical therapy alone or medical therapy plus CABG Methods Eligible for enrollment Patients with angiographic documentation of coronary artery disease amenable to surgical revascularization and with left ventricular systolic dysfunction (ejection fraction, ≤35%) Exclusion criteria Left main coronary artery stenosis of more than 50% Cardiogenic shock Myocardial infarction within 3 months Need for aortic-valve surgery Methods Classify patients : having or not substantial myocardial viability SPECT : 11 or more viable segments on the basis of relative tracer activity Dobutamine echocardiography : 5 or more segments with abnormal resting systolic function but manifesting contractile reserve during dobutamine administration End points Primary : death from any cause Secondary : death from cardiovascular causes and a composite of death from any cause or hospitalization for cardiovascular causes RESULTS Patients Assessment of myocardial viability 601 With myocardial viability Without myocardial viability 487 CABG + 244 114 CABG - 243 CABG + 54 CABG - 60 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.