title: Long-term outcome and the use of revascularization in patients with heart failure, suspected ischemic heart disease, and large reversible myocardial perfusion defects.
abstract: BACKGROUND
  The potential role of coronary revascularization in the management of patients with congestive heart failure and suspected ischemic heart disease remains to be defined. Myocardial perfusion imaging can identify patients with ischemic heart disease as the etiology for left ventricular dysfunction who might benefit from revascularization.
  
  
  METHODS
  We retrospectively identified heart failure patients with suspected ischemic heart disease who had large reversible perfusion defects to determine their long-term outcome and rate of revascularization. The study group consisted of 77 patients with congestive heart failure, left ventricular ejection fraction <45%, and suspected ischemic heart disease who underwent myocardial perfusion imaging during the period of January 1, 1991, to December 31, 1997, and had large reversible perfusion defects.
  
  
  RESULTS
  The 5-year mortality rate was 57.6%. The revascularization rate was only 13% for 5 years of follow-up. The number of patients undergoing revascularization was too small to assess its impact on outcome.
  
  
  CONCLUSIONS
  These results indicate a high 5-year mortality rate and a low utilization of coronary revascularization in patients with heart failure and large reversible perfusion defects. The low rate of revascularization reflects at least in part the absence of the generalizability of the existing literature to the optimal means of treating patients with heart failure and myocardial ischemia and points to the need for a randomized clinical trial.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine and the Section of Biostatistics, Mayo Clinic, Rochester, MN 55905, USA. miller.wayne@mayo.edu
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Miller
authors.forename: Susan K
authors.initials: SK
authors.lastname: Tointon
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Susan M
authors.initials: SM
authors.lastname: Nelson
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Rodeheffer
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Gibbons
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003326:Coronary Circulation; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality / Q000601:surgery*; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology