TY - JOUR
T1 - Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction
T2 - A meta-analysis
AU - Allman, Kevin C.
AU - Shaw, Leslee J.
AU - Hachamovitch, Rory
AU - Udelson, James E.
PY - 2002/4/3
Y1 - 2002/4/3
N2 - OBJECTIVES: This study pools data from published series examining late survival with revascularization versus medical therapy after myocardial viability testing in patients with severe coronary artery disease (CAD) and left ventricular (LV) dysfunction. BACKGROUND: Previous observational studies have suggested survival benefit in such patients if they are revascularized when myocardial viability is detected on imaging tests. METHODS: A MEDLINE database search returned 24 viability studies reporting patient survival using thallium per fusion imaging, F-18 fluorodeoxyglucose metabolic imaging or dobutamine echocardiography. Annual death rates were extracted, pooled and analyzed with a random effects model. The risk-adjusted relationship between severity of LV dysfunction, presence of viability and survival benefit associated with revascularization was assessed by metaregression. RESULTS: There were 3,088 patients (2,228 men), ejection fraction 32 ± 8%, followed for 25 ± 10 months. In patients with viability, revascularization was associated with 79.6% reduction in annual mortality (16% vs. 3.2%, chi-square = 147, p < 0.0001) compared with medical treatment. Patients without viability had intermediate mortality, trending to higher rates with revascularization versus medical therapy (7.7% vs. 6.2%, p = NS). Patients with viability showed a direct relationship between severity of LV dysfunction and magnitude of benefit with revascularization (p < 0.001). There was no measurable performance difference for predicting revascularization benefit between the three testing techniques. CONCLUSIONS: This meta-analysis demonstrates a strong association between myocardial viability on noninvasive testing and improved survival after revascularization in patients with chronic CAD and LV dysfunction. Absence of viability was associated with no significant difference in outcomes, irrespective of treatment strategy.
AB - OBJECTIVES: This study pools data from published series examining late survival with revascularization versus medical therapy after myocardial viability testing in patients with severe coronary artery disease (CAD) and left ventricular (LV) dysfunction. BACKGROUND: Previous observational studies have suggested survival benefit in such patients if they are revascularized when myocardial viability is detected on imaging tests. METHODS: A MEDLINE database search returned 24 viability studies reporting patient survival using thallium per fusion imaging, F-18 fluorodeoxyglucose metabolic imaging or dobutamine echocardiography. Annual death rates were extracted, pooled and analyzed with a random effects model. The risk-adjusted relationship between severity of LV dysfunction, presence of viability and survival benefit associated with revascularization was assessed by metaregression. RESULTS: There were 3,088 patients (2,228 men), ejection fraction 32 ± 8%, followed for 25 ± 10 months. In patients with viability, revascularization was associated with 79.6% reduction in annual mortality (16% vs. 3.2%, chi-square = 147, p < 0.0001) compared with medical treatment. Patients without viability had intermediate mortality, trending to higher rates with revascularization versus medical therapy (7.7% vs. 6.2%, p = NS). Patients with viability showed a direct relationship between severity of LV dysfunction and magnitude of benefit with revascularization (p < 0.001). There was no measurable performance difference for predicting revascularization benefit between the three testing techniques. CONCLUSIONS: This meta-analysis demonstrates a strong association between myocardial viability on noninvasive testing and improved survival after revascularization in patients with chronic CAD and LV dysfunction. Absence of viability was associated with no significant difference in outcomes, irrespective of treatment strategy.
UR - http://www.scopus.com/inward/record.url?scp=0037012432&partnerID=8YFLogxK
U2 - 10.1016/S0735-1097(02)01726-6
DO - 10.1016/S0735-1097(02)01726-6
M3 - Article
C2 - 11923039
AN - SCOPUS:0037012432
SN - 0735-1097
VL - 39
SP - 1151
EP - 1158
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 7
ER -