Efficacy of coronary angioplasty for the treatment of hibernating myocardium

Objectives-To determine the efficacy of coronary angioplasty as the sole me thod of revascularisation in patients with coronary artery disease and chro nically dysfunctional but viable myocardium (hibernating myocardium), and t o assess the effect of restenosis on functional outcome. Design and patients-24 consecutive patients with hibernating myocardium wer e studied. Positron emission tomography was used to assess myocardial viabi lity, blood flow, and flow reserve. One patient refused angioplasty, one ha d bypass surgery, and one died while waiting for an elective procedure. The procedure failed in three patients. The remaining 18 patients had repeat e chocardiography, 15 had repeat coronary angiography, and nine had repeat as sessments of blood flow and flow reserve at mean (SD) 17 (2) weeks after an gioplasty. In three patients restenosis was documented. Results-The wall motion score index in the revascularised territories impro ved from 1.71 (0.37) to 1.34 (0.47) (p = 0.008). Thirty of 51 dysfunctional segments improved in territories without restenosis compared with three of 14 in restenosed territories (p = 0.001). Hibernating and normal segments had comparable flows (0.82 (0.26) v 0.89 (0.24) ml/min/g; NS) while flow re serve was lower in hibernating segments (1.55 (0.68) v 2.07 (1.08); p = 0.0 3). In segments without restenosis flow reserve improved from 2.03 (1.25) t o 2.33 (1.4) (p = 0.03). Sensitivity, specificity, and positive and negativ e predictive accuracy of the viability study were 97%, 77%, 82%, and 96%, r espectively. After excluding patients with restenosis, specificity and posi tive predictive accuracy improved to 90% and 93%. Conclusions-Angioplasty improves function in hibernating myocardium, and re stenosis prevents recovery; hibernating myocardium is characterised by an i mpairment of flow reserve; restenosis affects the diagnostic accuracy of vi ability studies.