Abstract 17656: Incomplete Revascularization following Viability Assessment with MRI Is an Independent and Incremental Predictor of Mortality in Patients with Severe Ischemic Cardiomyopathy
BACKGROUND: Controversy remains regarding the impact viable myocardium (VM) on predicting adverse outcomes in pts with ischemic cardiomyopathy (ICM). Previous work suggested failure to undergo revascularization (RVS) in pts with VM was associated with adverse outcome, but the presence of degree of incomplete revascularization (IR) on survival is undefined. We hypothesized that degree of IR after VM assessment in severe ICM provides independent and incremental value in the prognostication of all-cause mortality over clinical, echocardiographic, and delayed-enhancement (DE-MRI) VM data.
METHODS: We studied 411 pts with ischemic cardiomyopathy (LV dysfunction with >70% stenosis in ≥1 epicardial coronary artery) undergoing DE-MRI (Avanto, Siemens) between 2002-2006. Scar was defined as ≥2SD of the defined remote myocardium. 238(58%) pts underwent subsequent RVS. IR was identified when >70% stenosis in a major coronary vessel with <50% scar did not undergo RVS of the corresponding vascular territory. A multivariable Cox proportional hazards (CPH) model was used to evaluate the association of IR with survival.
RESULTS: Of 411 pts (mean LVEF 23±9%, mean ESVi 115±48 ml, mean scar % 30 ± 17%; 193(38%) patients had IR, and 186 deaths (45%) occurred over a mean 5.5y follow-up. CPH showed IR to be associated with mortality, independent of usual correlates of survival (Table). IR was also incremental to the other determinants (model X2 increased from 125 to 137 with addition of IR). Importantly, degree of IR was associated with outcome (Figure 1).
CONCLUSION: Association of degree of IR with outcome supports the prognostic importance of VM in pts with severe ICM.
- © 2012 by American Heart Association, Inc.