title: Early versus delayed revascularization in patients with ischemic cardiomyopathy and substantial viability: impact on outcome.
abstract: BACKGROUND
  Patients with ischemic cardiomyopathy and viable myocardium may improve in function and prognosis following revascularization. Delayed revascularization may result in less favorable outcome, and therefore the impact of timing of revascularization on long-term outcome was evaluated.
  
  
  RESULTS
  Patients (n=85) with ischemic cardiomyopathy and substantial viability (>or=25% of the left ventricle) on dobutamine stress echocardiography underwent surgical revascularization. Based on the waiting time for revascularization, patients were divided into 2 groups: early (<or=1 month) and late (>1 month) revascularization. Left ventricular ejection fraction (LVEF) was assessed before and 9 to 12 months after revascularization; follow-up data were acquired up to 2 years after revascularization. Hence, 40 patients underwent early (20+/-12 days) and 45 late (85+/-47 days) revascularization. Baseline characteristics of the two groups were comparable. Preoperative deaths were 0 in the early and 2 in the late group. Patients with early revascularization remained shorter time in the intensive care unit (2.4+/-1.5 days versus 5.9+/-2.1 days for the late group, P<0.05). Low output syndrome was observed more frequently in the late group (8% versus 22%, P=0.06). On long-term follow-up, mortality (5% versus 20%, P<0.05) and re-hospitalization for heart failure (10% versus 24%, NS) were higher in the late group. LVEF improved from 28+/-9% to 40+/-12% (P<0.05) in the early group and remained unchanged in the late group (27+/-10% versus 25+/-7%, NS).
  
  
  CONCLUSIONS
  Patients with ischemic cardiomyopathy and viable myocardium benefit from early revascularization (with improvement in LVEF and favorable prognosis), whereas delayed revascularization of these patients is associated with worse outcome.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, The Netherlands. jbax@knoware.nl
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rizzello
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Alexander
authors.initials: A
authors.lastname: Maat
authors.forename: Jos R T C
authors.initials: JR
authors.lastname: Roelandt
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D002303:Cardiac Output, Low / Q000601:surgery; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000601:surgery*; D009204:Myocardial Revascularization / Q000401:mortality; D017682:Myocardial Stunning / Q000175:diagnosis / Q000601:surgery; D009426:Netherlands / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome