Early versus delayed revascularization in patients with ischemic cardiomyopathy and substantial viability: Impact on outcome

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 ( greater than or equal to 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 ( less than or equal to 1 month) and late ( > 1 month) revascularization. Left ventricular ejection fraction (LVEF) was assessed before and 9 to 12 months after revascularization; follow-up data were acquired up to 2 years after revascularization. Hence, 40 patients underwent early ( 20 +/- 12 days) and 45 late ( 85 +/- 47 days) revascularization. Baseline characteristics of the two groups were comparable. Preoperative deaths were 0 in the early and 2 in the late group. Patients with early revascularization remained shorter time in the intensive care unit (2.4 +/- 1.5 days versus 5.9 +/- 2.1 days for the late group, P < 0.05). Low output syndrome was observed more frequently in the late group (8% versus 22%, P = 0.06). On long-term follow-up, mortality (5% versus 20%, P < 0.05) and re-hospitalization for heart failure (10% versus 24%, NS) were higher in the late group. LVEF improved from 28 +/- 9% to 40 +/- 12% ( P < 0.05) in the early group and remained unchanged in the late group ( 27 +/- 10% versus 25 +/- 7%, NS). Conclusion - 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.