Coronary revascularisation for postischaemic heart failure: how myocardial viability affects survival

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Abstract
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 ⩾ III), mean left ventricular ejection fraction (LVEF) 24 (7)% (range 10–35%), and limited exercise capacity (peak oxygen consumption (VO 2) 15 (4) ml/kg/min) were studied. 21/35 patients had no angina. Myocardial viability was assessed with quantitative positron emission tomography and the glucose analogue18F-fluorodeoxyglucose (FDG) (viable segment = FDG uptake ⩾ 0.25 μmol/min/g) in all patients before coronary artery bypass grafting. Patients were divided into two groups: group 1, ⩾ 8 viable dysfunctional segments (mean 12 (2), range 8–15); and group 2, < 8 viable dysfunctional segments (mean 3.5 (3), range 0–7). The two groups were comparable for age, sex, NYHA class, LVEF, and peak VO 2. RESULTS Two patients died perioperatively and seven patients died during follow 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 ⩾ 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 associated with good survival, which is critically dependent upon the amount of viable myocardium.