DELAY IN REVASCULARIZATION IS ASSOCIATED WITH INCREASED MORTALITY-RATE IN PATIENTS WITH SEVERE LEFT-VENTRICULAR DYSFUNCTION AND VIABLE MYOCARDIUM ON FLUORINE 18-FUORODEOXYGLUCOSE POSITRON-EMISSION-TOMOGRAPHY IMAGING

Background-The identification of high-risk patients who require early revascularization has become increasingly important with the present e mphasis on reducing health care resources. This is particularly releva nt to health care systems with prolonged waiting times for interventio ns. Myocardial viability imaging with the use of fluorine 18-fluorodeo xyglucose (FDG) PET may help to identify high-risk patients with sever e left ventricular dysfunction. The aim of this study was to evaluate the consequences of prolonged waiting time on cardiac outcomes in pati ents with left ventricular dysfunction directed to revascularization b ased on FDG PET imaging. Methods and Results-Forty-six patients with c oronary disease and an ejection fraction of less than or equal to 35% were considered candidates for revascularization based on FDG PET viab ility imaging. Thirty-five of 46 patients were subsequently accepted f or revascularization. Patients were divided into 2 groups based on the median waiting time after PET: an early group (<35 days; n=18) and a late group (greater than or equal to 35 days; n=17). Preoperative mort ality rates were significantly increased in the late group (4 of 17 [2 4%] versus 0 of 18 in the early group; P<0.05). In postoperative follo w-up (17+/-7 months), cardiac events occurred in 2 of 18 (11%) and 1 o f 13 (7.8%) patients in the early and late groups, respectively. Left ventricular ejection fraction increased after early revascularization (24+/-7% to 29+/-8%, P<0.001, baseline versus 3 months) but not in the late group (27+/-5% to 28+/-6%, P=NS). Conclusions-Preoperative FDG P ET can be used to identify a high-risk group of patients who may benef it from early revascularization. A long waiting time for revasculariza tion is associated with a high mortality rate and suggests that early revascularization is desirable after the identification of hibernating viable myocardium.