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(Circulation. 2006;113:180-182.)
© 2006 American Heart Association, Inc.

Editorial

Revascularization in Systolic Heart Failure

A Difficult Decision

Raymond J. Gibbons, MD; Panithaya Chareonthaitawee, MD; Kent R. Bailey, PhD

From the Mayo Clinic College of Medicine, Rochester, Minn.

Correspondence to Dr R.J. Gibbons, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905. E-mail gibbons.raymond@mayo.edu

Key Words: Editorials • heart failure • revascularization

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Clinicians frequently face difficult decisions regarding coronary revascularization in patients with left ventricular systolic dysfunction and heart failure. Their ability to balance the potential, although somewhat uncertain, benefits of revascularization with the greater-than-usual periprocedural risks in this population is complicated by the lack of completed randomized trials and the limitations of the existing scientific literature.¹ In this issue, Tarakji et al² report on 765 consecutive patients with ejection fraction 35% and heart failure who underwent positron emission tomography (PET), including fluorodeoxyglucose (FDG) imaging. From a propensity analysis matching 153 patients who underwent early intervention with 153 patients who did not, they conclude that "early intervention may be associated with improved survival regardless of the degree of viability."

Article p 230

Compared with the existing literature, this study has a number of noteworthy strengths. The number of patients reported here is noticeably larger than in previous studies. In 1 meta-analysis,³ the largest number of previously reported PET patients in a single study was 161. A more recent PET series⁴ reported on 261 patients. The 765 patients reported by Tarakji et al constitute a far larger group.

The authors carefully compared the 230 patients who underwent intervention with the 535 who did not and identified important differences in both clinical characteristics and PET/FDG image findings between these 2 groups. They included patients who did not undergo revascularization and those who died undergoing revascularization, groups that frequently have been excluded from prior reports.

The authors acquired 3 separate PET images: A resting rubidium-82 . . . [Full Text of this Article]