Myocardial Viability and Long-Term Outcomes in Ischemic Cardiomyopathy
Key result
CABG plus medical therapy reduces all-cause mortality ~27% vs medical therapy, regardless of myocardial viability.
- HR 0.73
- 95% CI 0.60-0.90
- n=601
Why the study?
The role of myocardial viability assessment in identifying patients with ischemic cardiomyopathy who benefit from surgical revascularization, and the relationship between left ventricular function improvement and subsequent outcomes, remained controversial and unclear.
Does CABG plus medical therapy reduce death from any cause compared to medical therapy alone in patients with ischemic cardiomyopathy, and is this benefit dependent on myocardial viability?
Population
601 patients with CAD amenable to CABG and LVEF 35% or lower undergoing viability assessment
Comparison
CABG plus medical therapy vs medical therapy alone
Design
Randomized trial
Follow-up
Median 10.4 years
Authors
Discussion
Loading...
Member takes
Implication
CABG improves survival in ischemic cardiomyopathy regardless of viability; challenges viability testing to guide revascularization decisions.
Key Points
- To determine whether assessment of myocardial viability identifies patients with ischemic cardiomyopathy and severe left ventricular dysfunction who derive long-term survival benefit from surgical revascularization.
- Randomized trial (STICH, NCT00023595) enrolling 601 patients with coronary artery disease and left ventricular ejection fraction (LVEF) ≤35% assigned to CABG plus medical therapy or medical therapy alone.
- Myocardial viability was prospectively assessed using single-photon-emission computed tomography, dobutamine echocardiography, or both, with a median follow-up of 10.4 years.
- LVEF was assessed at baseline and 4 months in 318 patients; the primary endpoint was all-cause mortality.
- CABG plus medical therapy significantly reduced all-cause death compared with medical therapy alone (182/298 vs 209/303; adjusted HR 0.73; 95% CI, 0.60 to 0.90).
- No significant interaction was observed between myocardial viability status and the treatment benefit of CABG (P=0.34 for interaction).
- LVEF improvement occurred only in patients with viable myocardium regardless of treatment group, but changes in LVEF were not associated with subsequent survival.
Study Design
Type
RCT (n=601)
Randomization
Randomized
Structured PICO
Does CABG plus medical therapy reduce death from any cause compared to medical therapy alone in patients with ischemic cardiomyopathy, and is this benefit dependent on myocardial viability?
P
Population
601 patients with coronary artery disease amenable to coronary-artery bypass grafting (CABG) and left ventricular ejection fraction of 35% or lower, who underwent prospective myocardial viability assessment.
I
Intervention
Coronary-artery bypass grafting (CABG) plus medical therapy
C
Comparator
Medical therapy alone
O
Outcome
Death from any causehard clinical
Main Result
Effect estimate: HR 0.73 (95% CI 0.60-0.90)
Absolute Event Rate: 61.1% vs 69%
In patients with ischemic cardiomyopathy, CABG improves long-term survival compared to medical therapy alone regardless of myocardial viability, challenging the utility of viability testing for selecting patients for surgical revascularization.
Cite This Study
Panza et al. (2019) conducted an RCT in Ischemic cardiomyopathy (n=601). CABG plus medical therapy vs. Medical therapy alone was evaluated on Death from any cause (HR 0.73, 95% CI 0.60-0.90). CABG plus medical therapy reduced death from any cause compared to medical therapy alone (HR 0.73; 95% CI 0.60-0.90), with no significant interaction based on myocardial viability (P=0.34).