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Title: Outcomes of Coronary Artery Bypass Grafting in Patients With Poor Myocardial Viability: A Systematic Review and Meta-Analysis of the Last Decade.
Austin Authors: Sharma, Varun J;Arghami, Arman;Pasupala, Deepak;Haddad, Abdullah;Ke, Janny Xue Chen
Affiliation: Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA..
Cardiac Surgery
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA..
Department of Cardiology, MercyOne North Iowa Medical Center, Mason City, IA, USA..
Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Canada..
Department of Anesthesia, Providence Health Care, Vancouver, Canada..
Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada..
Issue Date: 23-Mar-2022
Date: 2022
Publication information: Heart, lung & circulation 2022; online first: 23 March
Abstract: Our objective is to assess whether the presence of myocardial viability is a predictor of mortality among patients undergoing coronary artery bypasss grafting (CABG) through a systematic review meta-analysis. Comprehensive review of EMBASE and PubMed in accordance with PRISMA guidelines, including studies of patients undergoing CABG with assessment of myocardial viability and recorded long-term mortality, age and sex. Studies were restricted to the last decade, and data were stratified by imaging modality (magnetic resonance imaging [MRI] or nuclear medicine). Random-effects model for assessing pooled effect, heterogeneity assessment using Chi-square and I2 statistics, publication bias assessed by funnel plots and Egger's test. Meta-analysis of contemporary data (January 2010 to October 2020) yielded 3,621 manuscripts of which 92 were relevant, and 6 appropriate for inclusion with 993 patients. Pooled analysis showed that patients with non-viable myocardium undergoing CABG are at 1.34 the risk of mortality compared to those with viable myocardium (95% CI 1.01-1.79 p=0.05). Subgroup analysis of the MRI or nuclear medicine modalities was not statistically significant and there was no confounding by age or sex in meta-regression. There was significant heterogeneity in imaging modality and diagnostic criteria, but heterogeneity between study findings was low with an I2 statistic of 29%. The risk of publication bias was moderate on the Newcastle-Ottawa Scale), but not statistically significant (Egger's Test coefficient=1.3 95%CI -0.35-2.61 p=0.10). There's a multitude of methods for assessing cardiac viability for coronary revascularisation surgery, making meta-analyses fraught with limitations. Our meta-analysis demonstrates that the finding of non-viable myocardium can not be used draw conclusions for risk assessment in coronary surgery.
DOI: 10.1016/j.hlc.2021.12.016
ORCID: 0000-0002-5008-4113
Journal: Heart, lung & circulation
PubMed URL: 35339371
PubMed URL:
Type: Journal Article
Subjects: Coronary artery bypass grafting
Myocardial viability
Appears in Collections:Journal articles

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