title: Myocardial viability and survival in ischemic left ventricular dysfunction.
abstract: BACKGROUND
  The assessment of myocardial viability has been used to identify patients with coronary artery disease and left ventricular dysfunction in whom coronary-artery bypass grafting (CABG) will provide a survival benefit. However, the efficacy of this approach is uncertain.
  
  
  METHODS
  In a substudy of patients with coronary artery disease and left ventricular dysfunction who were enrolled in a randomized trial of medical therapy with or without CABG, we used single-photon-emission computed tomography (SPECT), dobutamine echocardiography, or both to assess myocardial viability on the basis of prespecified thresholds.
  
  
  RESULTS
  Among the 1212 patients enrolled in the randomized trial, 601 underwent assessment of myocardial viability. Of these patients, we randomly assigned 298 to receive medical therapy plus CABG and 303 to receive medical therapy alone. A total of 178 of 487 patients with viable myocardium (37%) and 58 of 114 patients without viable myocardium (51%) died (hazard ratio for death among patients with viable myocardium, 0.64; 95% confidence interval [CI], 0.48 to 0.86; P=0.003). However, after adjustment for other baseline variables, this association with mortality was not significant (P=0.21). There was no significant interaction between viability status and treatment assignment with respect to mortality (P=0.53).
  
  
  CONCLUSIONS
  The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables. The assessment of myocardial viability did not identify patients with a differential survival benefit from CABG, as compared with medical therapy alone. (Funded by the National Heart, Lung, and Blood Institute; STICH ClinicalTrials.gov number, NCT00023595.).
authors.affiliation: Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave., Suite 1006, Chicago, IL 60611, USA. r-bonow@northwestern.edu
authors.forename: Robert O
authors.initials: RO
authors.lastname: Bonow
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Holly
authors.forename: Philip F
authors.initials: PF
authors.lastname: Binkley
authors.forename: Patrice
authors.initials: P
authors.lastname: Desvigne-Nickens
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Drozdz
authors.forename: Pedro S
authors.initials: PS
authors.lastname: Farsky
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Feldman
authors.forename: Torsten
authors.initials: T
authors.lastname: Doenst
authors.forename: Robert E
authors.initials: RE
authors.lastname: Michler
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Jose C
authors.initials: JC
authors.lastname: Nicolau
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Wrobel
authors.forename: Nasri
authors.initials: N
authors.lastname: Alotti
authors.forename: Federico M
authors.initials: FM
authors.lastname: Asch
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Favaloro
authors.forename: Lilin
authors.initials: L
authors.lastname: She
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Robert H
authors.initials: RH
authors.lastname: Jones
authors.forename: Julio A
authors.initials: JA
authors.lastname: Panza
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D009206:Myocardium / Q000473:pathology*; D016016:Proportional Hazards Models; D018709:Statistics, Nonparametric; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*