PROGNOSTIC IMPACT OF MYOCARDIAL VIABILITY TESTING IN 3088 PATIENTS:
A META-ANALYSIS KC. Allman*, LJ. Shaw, R. Hachamovitch,
JE. Udelson. Concord Hospital Sydney and Tufts New
England Medical Center, Boston MA, USA. Aim: To examine the effects of treatment strategy (revascularization:
‑-REVS vs medical therapy: . MED) on clinical outcomes in
patients with coronary artery disease and left ventricular dysfunction
following myocardial viability testing. Methods: A literature search identified 24 viability studies
(TI-201, FDG or echo) reporting late patient outcomes. Annual
rates of cardiac death and nonfatal events (infarction, heart failure,
unstable angina) were extracted from the papers and pooled data
meta‑-analyzed using a random effects model. Results: There were 3088 patients, 2164 men, ejection fraction
32±8% follow up 25±10mths. 35% underwent REV,
65% MED. In patients with viability REV was associated with
an almost 80% relative reduction in death (16% to 3.2%, chi-square
147, p<0.0001) and 51% reduction in all other events (12.2% to
6.0%, P<0.001) compared with MED. Patients without viability
had intermediate rates for all events with a slight trend to higher
rates with REV vs MED (death 7.7% vs 6.2%, other events 10.2% vs
8.0%, both p=ns). Conclusion: Viability testing identifies high risk patients whose prognosis
is significantly improved with revascularization. Conversely, patients without viability are at intermediate risk
which is not improved by REV. These
results provide compelling evidence for the use of viability testing in
coronary artery disease patients with left ventricular dysfunction to direct
therapy.
