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ACC: No Survival Benefit With CABG in Heart Failure

Myocardial viability unable to identify patients with a differential survival benefit from CABG

MONDAY, April 4 (HealthDay News) -- In patients with coronary artery disease (CAD) and heart failure, there is not a significant difference between medical therapy alone or with coronary artery bypass grafting (CABG) with respect to the rate of death from any cause; and, in patients with CAD and left ventricular dysfunction, myocardial viability is unable to identify those with a differential survival benefit from CABG, according to research published online April 4 in the New England Journal of Medicine to coincide with the American College of Cardiology's 60th Annual Scientific Session & Expo, held from April 2 to 5 in New Orleans.

Eric J. Velazquez, M.D., of the Duke University Medical Center in Durham, N.C., and colleagues randomized 1,212 patients with an ejection fraction of 35 percent or less and CAD amenable to CABG to medical therapy alone or medical therapy plus CABG. The investigators found that there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to death from any cause; however, those assigned to medical therapy plus CABG had lower rates of death from cardiovascular causes (hazard ratio [HR] with CABG, 0.81; P = 0.05) and death from any cause or hospitalization for cardiovascular causes (HR with CABG, 0.74; P < 0.001).

In a sub-study of patients with CAD and left ventricular dysfunction who were enrolled in the randomized trial of medical therapy with or without CABG, Robert O. Bonow, M.D., of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues used single-photon-emission computed tomography, dobutamine echocardiography, or both to assess myocardial viability on the basis of pre-specified thresholds. Of 601 patients who underwent myocardial viability assessment, the investigators randomized 298 to receive medical therapy plus CABG and 303 to receive medical therapy alone. The investigators were unable to find a differential survival benefit from CABG as compared to medical therapy alone.

"The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables," Bonow and colleagues write.

The first study was funded, in part, by Abbott Laboratories. Several authors from both studies disclosed financial relationships with either pharmaceutical, biotechnology, or medical device companies.

Abstract - Velazquez
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Abstract - Bonow
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