Document Detail


Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions.
MedLine Citation:
PMID:  9832692     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Our purpose was to evaluate the long-term benefit of myocardial viability assessment for stratifying risk and selecting patients with low ejection fraction for coronary artery bypass grafting and to determine the relation between the severity of anginal symptoms, the amount of ischemic myocardium, and clinical outcome. METHODS: We studied 93 consecutive patients with severe coronary artery disease and low ejection fraction (median, 25%) who underwent positron emission tomography to delineate the extent of perfusion-metabolism mismatch (reflecting hibernating myocardium) for potential myocardial revascularization. Median follow-up was 4 years (range, 0 to 6.2 years). RESULTS: Fifty patients received medical therapy, and 43 patients underwent bypass grafting. In Cox survival models, heart failure class, prior myocardial infarction, and positron emission tomographic mismatch were the best predictors of survival. Patients with positron emission tomographic mismatch receiving bypass grafting had improved 4-year survival compared with those on medical therapy (75% versus 30%; P =.007) and a significant improvement in angina and heart failure symptoms. In patients without positron emission tomographic mismatch, bypass grafting tended to improve survival and symptoms only in those patients with severe angina (100% versus 60%; P =.085), whereas no survival advantage was apparent in patients with minimal or no anginal symptoms (63% versus 52%; P =.462). CONCLUSIONS: Patients with low ejection fraction and evidence of viable myocardium by positron emission tomography have improved survival and symptoms with coronary bypass grafting compared with medical therapy. In patients without evidence of viability, survival and symptom improvement with bypass grafting are apparent only among those patients with severe angina.
Authors:
M F Di Carli; J Maddahi; S Rokhsar; H R Schelbert; D Bianco-Batlles; R C Brunken; B Fromm
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  116     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1998 Dec 
Date Detail:
Created Date:  1999-01-06     Completed Date:  1999-01-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  997-1004     Citation Subset:  AIM; IM    
Affiliation:
Division of Nuclear Medicine, Department of Medical and Molecular Pharmacology, UCLA School of Medicine, Los Angeles, CA, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cause of Death
Coronary Angiography
Coronary Artery Bypass*
Coronary Disease / diagnosis,  mortality*,  surgery
Decision Making*
Female
Follow-Up Studies
Humans
Male
Retrospective Studies
Severity of Illness Index
Stroke Volume
Survival Rate
Tomography, Emission-Computed
Treatment Outcome
Ventricular Dysfunction, Left / diagnosis,  mortality*,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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