Abstract 3120: Impact of Preoperative Patient Selection by Myocardial Viability Assessment via PET in Patients with Severe Impaired LV-Function After CABG
Background: Patients with ischemic cardiomyopathy are at increased risk for cardiac events and death when undergoing coronary artery bypass grafting (CABG). Therefore, the selection of patients who will benefit from CABG is an important clinical issue. This study sought to investigate whether improved patient selection by preoperative viability assessment by means of positron emission tomography (PET) results in improved survival after CABG.
Methods and Results: We reviewed 476 patients with ischemic cardiomyopathy (LV ejection fraction ≤ 0.35) who were considered candidates for CABG between 1994 and 2004. 152 of 178 patients were selected according to extent of viable tissue determined by PET (group A) in addition to clinical presentation and angiographic data, 298 patients were selected for CABG on the basis of clinical presentation and angiographic data only (group B). 26 patients were excluded from CABG because of lack of viability (group C). There were 2 in hospital deaths in group A (1.3%) and 30 (10.1%) in group B (p=0.018). The survival rate after 1, 5 and 9.3 years were in group A 92.0%, 73.3% and 54.2% and in group C 88.9%, 62.2% and 35.5% (p=0.005). Cox-regression analysis revealed an influence of preoperative viability assessment on long-term survival (p=0.008), of LV-function (p=0.017), and age>70 (p=0.016).
Conclusions: These data demonstrate that preoperative selection of patients with ischemic cardiomyopathy on the basis of viability assessment supplementary to clinical and angiographic data has a significant influence on postoperative survival. Therefore, viability assessment is recommended in this high risk patient population.