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Early versus delayed revascularization in patients with ischemic cardiomyopathy and substantial viability: impact on
Jeroen J Bax1, Arend F L Schinkel, Eric Boersma
1Department of Cardiology, Leiden University Medical Center, The Netherlands. jbax@knoware.nl
Insights
Early revascularization in patients with ischemic cardiomyopathy and viable myocardium improves left ventricular ejection fraction (LVEF) and prognosis. Delayed revascularization is linked to worse outcomes and higher mortality.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Ischemic cardiomyopathy with viable myocardium can improve post-revascularization.
- Timing of revascularization may impact long-term patient outcomes.
- Evaluating the effect of revascularization timing is crucial for patient prognosis.
Purpose of the Study:
- To evaluate the impact of revascularization timing on long-term outcomes in patients with ischemic cardiomyopathy.
- To compare functional and prognostic differences between early and late revascularization.
Main Methods:
- 85 patients with ischemic cardiomyopathy and significant myocardial viability underwent surgical revascularization.
- Patients were divided into early (<1 month) and late (>1 month) revascularization groups.
- Left ventricular ejection fraction (LVEF) and long-term outcomes (mortality, re-hospitalization) were assessed.
Main Results:
- Early revascularization (20 days) showed improved LVEF (28% to 40%) compared to late revascularization (85 days, no change).
- The late revascularization group experienced higher long-term mortality (20% vs. 5%) and re-hospitalization for heart failure.
- Early revascularization patients had shorter ICU stays and less frequent low output syndrome.
Conclusions:
- Early revascularization benefits patients with ischemic cardiomyopathy and viable myocardium, improving LVEF and prognosis.
- Delayed revascularization is associated with worse long-term outcomes, including increased mortality.
- Prompt surgical intervention is recommended for optimal results in this patient population.
Background:
Patients with ischemic cardiomyopathy and viable myocardium may improve in function and prognosis following revascularization. Delayed revascularization may result in less favorable outcome, and therefore the impact of timing of revascularization on long-term outcome was evaluated.
Methods And Results:
Patients (n=85) with ischemic cardiomyopathy and substantial viability (>or=25% of the left ventricle) on dobutamine stress echocardiography underwent surgical revascularization. Based on the waiting time for revascularization, patients were divided into 2 groups: early (
Conclusions:
Patients with ischemic cardiomyopathy and viable myocardium benefit from early revascularization (with improvement in LVEF and favorable prognosis), whereas delayed revascularization of these patients is associated with worse outcome.
