Related Experiment Video
Updated: Aug 30, 2025
Delayed Intramyocardial Delivery of Stem Cells after Ischemia Reperfusion Injury in a Murine Model
Published on: September 3, 2020
Do Patients With Non-Viable Myocardium From Ischemic Cardiomyopathy Benefit From Revascularization? A Systematic
Farideh Davoudi1, Satoshi Miyashita2, Tae Kyung Yoo3
1Department of Medicine, Mass General Brigham-Salem Hospital, MA, USA.
Insights
Revascularization benefits patients with ischemic cardiomyopathy and non-viable myocardium, reducing all-cause mortality compared to medical therapy alone. This finding challenges the necessity of myocardial viability for treatment selection.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Myocardial viability assessment guides revascularization decisions.
- Controversy exists regarding revascularization benefits in ischemic cardiomyopathy without viable myocardium.
Approach:
- Meta-analysis of 12 studies up to December 2021.
- Compared revascularization versus medical therapy in patients with non-viable myocardium.
- All-cause mortality was the primary outcome measure.
Key Points:
- 1363 patients with non-viable myocardium included (501 revascularization, 862 medical therapy).
- Revascularization significantly reduced all-cause mortality (RR 0.76, 95% CI: 0.62-0.93).
- No association found between viability imaging modality and mortality risk.
Conclusions:
- Revascularization offers a survival benefit in ischemic cardiomyopathy patients even without viable myocardium.
- This meta-analysis suggests revascularization is beneficial regardless of myocardial viability.
- Treatment decisions may not solely depend on demonstrating myocardial viability.
Background:
Myocardial viability assessment is used to select patients who will derive the greatest benefit from revascularization. It remains controversial whether revascularization only benefits patients with ischemic cardiomyopathy who have viable myocardium. The objective of this meta-analysis was to compare mortality between patients with ischemic cardiomyopathy and non-viable myocardium who underwent revascularization and those who underwent medical therapy alone.
Methods:
The MEDLINE database was searched using PubMed to retrieve studies published up to December 2021. Inclusion criteria were 1. studies that evaluated the impact of revascularization (revascularization group) versus medical therapy alone (control group) following myocardial viability assessment; 2. patients who had coronary artery disease that was amenable to coronary artery bypass grafting or percutaneous coronary intervention; and 3. patients who had non-viable myocardium. The main outcome measure was all-cause mortality.
Results:
A total of 12 studies were included, evaluating 1363 patients with non-viable myocardium, of whom 501 patients underwent revascularization and 862 patients received medical therapy alone. There was a significant reduction in all-cause mortality (RR 0.76, 95 % CI: 0.62-0.93, I2 = 0) in the revascularization group compared to the control group. There was no association between the type of viability imaging modality and the risk of all-cause mortality (P-interaction = 0.58).
Conclusions:
The findings of this meta-analysis suggest a benefit from revascularization compared to medical therapy in patients with ischemic cardiomyopathy despite the lack of myocardial viability.
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:30Cardiomyopathy II: Dilated Cardiomyopathy