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.