Angiography with intent to revascularize resulted in similar mortality compared to conservative management (38% vs 37%), though the trial was severely underpowered.
RCT (n=138)
Randomly assigned
Does angiography with intent to revascularize reduce mortality compared to conservative management in patients with heart failure, coronary artery disease, LVEF < 35%, and extensive myocardial viability?
In a severely underpowered trial of patients with ischemic heart failure and viable myocardium, an invasive strategy of intended revascularization did not demonstrate a survival benefit over conservative management.
Absolute Event Rate: 38% vs 37%
AIMS: Revascularization is frequently advocated to improve ventricular function and prognosis for patients with heart failure due to coronary artery disease, especially when there is evidence of extensive myocardial viability. METHODS AND RESULTS: Patients with heart failure, coronary artery disease, and a left ventricular (LV) ejection fraction < 35%, who had a substantial volume of viable myocardium with contractile dysfunction assessed by any standard imaging technique, were randomly assigned to a strategy of conservative management vs. angiography with the intent of percutaneous or surgical revascularization. Patients requiring revascularization for angina or too frail for surgery were excluded. Only 138 of the planned 800 patients were enrolled because of withdrawal of funding due to slow recruitment. Also, a larger trial (The Surgical Treatment for Ischemic Heart Failure Trial) addressing a similar question became available, which investigators were encouraged to join. Of 69 patients assigned to the invasive strategy, 6 refused angiography, 2 died as a result of the diagnostic procedure, 14 were considered unsuitable for revascularization, 2 refused surgery, and 45 had revascularization. After a median follow-up of 59 (inter-quartile range: 33-63) months, there were 51 (37%) deaths; 25 (37%) in those assigned to the conservative strategy, and 26 (38%) in those assigned to the invasive strategy, 13 (29%) of whom had been revascularized. CONCLUSION: A conservative management strategy may not be inferior to one of coronary arteriography with the intent to revascularize in patients with heart failure, LV systolic dysfunction, and extensive myocardial viability. However, this study was underpowered and, further, larger trials are required to settle this issue. Clinical trials Registration No: ISRCTN86284615.
Cleland et al. (Tue,) conducted a rct in Heart failure and coronary artery disease (n=138). Angiography with intent of percutaneous or surgical revascularization vs. Conservative management was evaluated on Death. Angiography with intent to revascularize resulted in similar mortality compared to conservative management (38% vs 37%), though the trial was severely underpowered.
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