Thomas A Holly1, Robert O Bonow2, J Malcolm O Arnold3, Jae K Oh4, Padmini Varadarajan5, Gerald M Pohost6, Haissam Haddad7, Robert H Jones8, Eric J Velazquez8, Bozena Birkenfeld9, Federico M Asch10, Marcin Malinowski11, Rodrigo Barretto12, Renato A K Kalil13, Daniel S Berman14, Jie-Lena Sun8, Kerry L Lee8, Julio A Panza15. 1. Northwestern University, Chicago, Ill. Electronic address: t-holly@northwestern.edu. 2. Northwestern University, Chicago, Ill. 3. University of Western Ontario, London, Ontario, Canada. 4. Mayo Clinic, Rochester, Minn. 5. Loma Linda University, Loma Linda, Calif. 6. University of Southern California, Los Angeles, Calif. 7. Ottawa Heart Institute, Ottawa, Ontario, Canada. 8. Duke University, Durham, NC. 9. Department of Nuclear Medicine PUM, Szczecin, Poland. 10. MedStar Washington Hospital Center, Washington, DC. 11. Medical University of Silesia, Katowice, Poland. 12. Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil. 13. Instituto de Cardiologia, Porto Alegre, Brazil. 14. Cedars-Sinai Medical Center, Los Angeles, Calif. 15. Westchester Medical Center, Valhalla, NY.
Abstract
OBJECTIVES: In the Surgical Treatment for Ischemic Heart Failure trial, surgical ventricular reconstruction plus coronary artery bypass surgery was not associated with a reduction in the rate of death or cardiac hospitalization compared with bypass alone. We hypothesized that the absence of viable myocardium identifies patients with coronary artery disease and left ventricular dysfunction who have a greater benefit with coronary artery bypass graft surgery and surgical ventricular reconstruction compared with bypass alone. METHODS:Myocardial viability was assessed by single photon computed tomography in 267 of the 1000 patients randomized to bypass or bypass plus surgical ventricular reconstruction in the Surgical Treatment for Ischemic Heart Failure. Myocardial viability was assessed on a per patient basis and regionally according to prespecified criteria. RESULTS: At 3 years, there was no difference in mortality or the combined outcome of death or cardiac hospitalization between those with and without viability, and there was no significant interaction between the type of surgery and the global viability status with respect to mortality or death plus cardiac hospitalization. Furthermore, there was no difference in mortality or death plus cardiac hospitalization between those with and without anterior wall or apical scar, and no significant interaction between the presence of scar in these regions and the type of surgery with respect to mortality. CONCLUSIONS: In patients with coronary artery disease and severe regional left ventricular dysfunction, assessment of myocardial viability does not identify patients who will derive a mortality benefit from adding surgical ventricular reconstruction to coronary artery bypass graft surgery.
RCT Entities:
OBJECTIVES: In the Surgical Treatment for Ischemic Heart Failure trial, surgical ventricular reconstruction plus coronary artery bypass surgery was not associated with a reduction in the rate of death or cardiac hospitalization compared with bypass alone. We hypothesized that the absence of viable myocardium identifies patients with coronary artery disease and left ventricular dysfunction who have a greater benefit with coronary artery bypass graft surgery and surgical ventricular reconstruction compared with bypass alone. METHODS: Myocardial viability was assessed by single photon computed tomography in 267 of the 1000 patients randomized to bypass or bypass plus surgical ventricular reconstruction in the Surgical Treatment for Ischemic Heart Failure. Myocardial viability was assessed on a per patient basis and regionally according to prespecified criteria. RESULTS: At 3 years, there was no difference in mortality or the combined outcome of death or cardiac hospitalization between those with and without viability, and there was no significant interaction between the type of surgery and the global viability status with respect to mortality or death plus cardiac hospitalization. Furthermore, there was no difference in mortality or death plus cardiac hospitalization between those with and without anterior wall or apical scar, and no significant interaction between the presence of scar in these regions and the type of surgery with respect to mortality. CONCLUSIONS: In patients with coronary artery disease and severe regional left ventricular dysfunction, assessment of myocardial viability does not identify patients who will derive a mortality benefit from adding surgical ventricular reconstruction to coronary artery bypass graft surgery.
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