Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis
Key result
Revascularization cuts annual mortality ~80% vs. medical therapy in CAD with LV dysfunction and viability.
- 79.6% reduction
- P<0.0001
- n=3,088
Why the study?
Previous observational studies suggested survival benefit from revascularization in patients with severe CAD and LV dysfunction when myocardial viability is detected, but pooled data were needed.
Population
3,088 patients with severe CAD and LV dysfunction (EF 32 +/- 8%)
Comparison
Revascularization versus medical therapy after myocardial viability testing
Design
Meta-analysis of 24 published viability studies using thallium, F-18 FDG, or dobutamine echocardiography
Follow-up
25 +/- 10 months
Authors
Discussion
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Implication
Meta-analysis reveals improved survival following revascularization in patients with viable myocardium and left ventricular dysfunction, highlighting the prognostic value of viability assessment.
Key Points
- To assess the prognostic impact of myocardial viability testing and subsequent coronary revascularization in patients with coronary artery disease and left ventricular dysfunction.
- Systematic review and meta-analysis evaluating clinical studies on myocardial viability testing.
- Analysis of survival and mortality outcomes comparing surgical or percutaneous revascularization against medical therapy based on the presence of viable myocardium.
- Coronary revascularization is associated with significant reductions in mortality compared to medical therapy alone in patients exhibiting demonstrable myocardial viability.
- Patients without viable myocardium do not show a significant survival advantage following revascularization compared with medical therapy.
Study Design
Type
Meta-Analysis (n=3,088)
PICO
P
Population
3,088 patients (27.8% female) with severe coronary artery disease and left ventricular dysfunction, followed for a mean of 25 months.
I
Intervention / Comparator
Revascularization vs Medical therapy
O
Primary Outcome
Annual mortality — 79.6% reduction, p=< 0.0001
Main Result
Effect estimate: 79.6% reduction
Absolute Event Rate: 3.2% vs 16%
p-value: p=< 0.0001
Cite This Study
Allman et al. (2002) conducted a meta-analysis in severe coronary artery disease and left ventricular dysfunction (n=3,088). Revascularization vs. Medical therapy was evaluated on Annual mortality (79.6% reduction, p=< 0.0001). In patients with CAD, LV dysfunction, and myocardial viability, revascularization reduced annual mortality compared with medical therapy (3.2% vs. 16%; P<0.0001).