Coronary revascularisation for postischaemic heart failure: how myocardialviability affects survival

Objective-To assess the impact of revascularisation of viable myocardium on survival in patients with postischaemic heart failure. Methods-35 patients (mean (SD) age 58 (7) years) with severe heart failure (New York Heart Association (NYHA) functional class greater than or equal t o III), mean left ventricular ejection fraction (LVEF) 24 (7)% (range 10-35 %), and limited exercise capacity (peak oxygen consumption (VO2) 15 (4) ml/ kg/min) were studied. 21/35 patients had no angina. Myocardial viability wa s assessed with quantitative positron emission tomography and the glucose a nalogue F-18-fluorodeoxyglucose (FDG) (viable segment = FDG uptake greater than or equal to 0.25 mu mol/min/g) in all patients before coronary artery bypass grafting. Patients were divided into two groups: group 1, greater th an or equal to 8 viable dysfunctional segments (mean 12 (2), range 8-15); a nd group 2, < 8 viable dysfunctional segments (mean 3.5 (3), range 0-7). Th e two groups were comparable for age, sex, NYHA class, LVEF, and peak VO2. Results-Two patients died perioperatively and seven patients died during fo llow up (mean 33 (14) months). All deaths were from cardiac causes. Kaplan- Meyer survival analysis showed 86% survival for group 1 patients versus 57% for group 2 (p = 0.03). Analysis by Cox proportional hazard model revealed three independent factors for cardiac event free survival: presence of gre ater than or equal to 8 viable segments (p = 0.006); preoperative LVEF (p = 0.002); and patient age (p = 0.01). Conclusion-Revascularisation for postischaemic heart failure can be associa ted with good survival, which is critically dependent upon the amount of vi able Kaplan-Meyer survival analysis showed 86% survival for myocardium.