Key result
≥8 viable segments is linked to a ~29% absolute survival increase after CABG in post-ischemic HF.
Why the study?
Does the presence of >= 8 viable myocardial segments improve survival in patients with postischaemic heart failure undergoing CABG compared to those with < 8 viable segments?
Cohort (n=35)
Does the presence of >= 8 viable myocardial segments improve survival in patients with postischaemic heart failure undergoing CABG compared to those with < 8 viable segments?
Absolute Event Rate: 86% vs 57%
p-value: p=0.03
In patients with severe postischaemic heart failure undergoing CABG, survival is significantly better in those with a higher amount of viable myocardium (>= 8 segments).
Viability assessment may refine prognosis after CABG in postischaemic HF; leaves open whether it should guide revascularization decisions.
OBJECTIVE: To assess the impact of revascularisation of viable myocardium on survival in patients with postischaemic heart failure. METHODS: 35 patients (mean (SD) age 58 (7) years) with severe heart failure (New York Heart Association (NYHA) functional class > or = III), mean left ventricular ejection fraction (LVEF) 24 (7)% (range 10-35%), and limited exercise capacity (peak oxygen consumption (VO(2)) 15 (4) ml/kg/min) were studied. 21/35 patients had no angina. Myocardial viability was assessed with quantitative positron emission tomography and the glucose analogue (18)F-fluorodeoxyglucose (FDG) (viable segment = FDG uptake > or = 0.25 micromol/min/g) in all patients before coronary artery bypass grafting. Patients were divided into two groups: group 1, > or = 8 viable dysfunctional segments (mean 12 (2), range 8-15); and group 2, < 8 viable dysfunctional segments (mean 3.5 (3), range 0-7). The two groups were comparable for age, sex, NYHA class, LVEF, and peak VO(2). RESULTS: Two patients died perioperatively and seven patients died during follow up (mean 33 (14) months). All deaths were from cardiac causes. Kaplan-Meyer survival analysis showed 86% survival for group 1 patients versus 57% for group 2 (p = 0.03). Analysis by Cox proportional hazard model revealed three independent factors for cardiac event free survival: presence of > or = 8 viable segments (p = 0.006); preoperative LVEF (p = 0.002); and patient age (p = 0.01). CONCLUSION: Revascularisation for postischaemic heart failure can be associated with good survival, which is critically dependent upon the amount of viable myocardium.
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Pagano et al. (1999) conducted a cohort in postischaemic heart failure (n=35). ≥8 viable dysfunctional segments vs. <8 viable dysfunctional segments was evaluated on survival (p=0.03). In patients with postischaemic heart failure undergoing CABG, the presence of ≥8 viable dysfunctional segments was associated with higher survival compared to <8 segments (86% vs 57%, p=0.03).
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