Ischemia Testing Before Coronary Artery Bypass Grafting: What's the Value Added?

In a substudy of the STICH trial, stress-induced ischemia predicted neither mortality nor increased benefit from CABG in patients with LV systolic dysfunction.

In the STICH trial, coronary artery bypass grafting (CABG) was not superior to medical therapy alone in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction, whether or not myocardial viability was identified (JW Cardiol Apr 4 2011). In this analysis, investigators examined the effects of inducible ischemia in a subset of 399 STICH patients (33% of those enrolled) who underwent stress testing with radionuclide studies, dobutamine echocardiology, or both.

In this cohort (mean LV ejection fraction, 26%), the rate of demonstrable myocardial ischemia was 64% and did not differ between the two test types. The extent of ischemia was ≥10% in 50% of the patients and was ≥20% in 19%. Outcomes, including all-cause mortalit…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)