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Rapid Fire Abstracts

Rapid Fire 05- CAD: Chronic Coronary Syndromes

Benefits of cardiovascular magnetic resonance viability to predict mortality following revascularization (RF_FR_294)

Friday, January 31, 2025
10:00 AM – 10:10 AM East Coast USA Time
Location: Blue Room PreFunction
Background:

After the REVIVED trial, the utility of cardiovascular magnetic resonance (CMR) assessing the myocardial viability to guide coronary revascularization remains controversial. In this study, we propose to assess the prognostic impact of coronary revascularization guided by CMR-based myocardial viability to predict death in patients with ischaemic cardiomyopathy (ICM) and reduced left ventricular ejection fraction (LVEF) < 50%.

Methods:

Between 2008 and 2022, we included all consecutive ICM patients referred for CMR-based myocardial viability assessment in a multicentric study. Eligible patients had a history of myocardial infarction, or prior coronary revascularization, and LVEF< 50%. We collected data on revascularization within 90 days of the index CMR. The primary endpoint was all-cause mortality. To define myocardial viability, ischaemic-late gadolinium enhancement (LGE) transmurality was assessed for maximal scar depth, considering myocardium with LGE transmurality < 50% as viable and ≥50% as non-viable.

Results:

Among 6,082 patients (mean age 65±12 years; 73% male), 3,591 (59%) exhibited ischaemic-LGE. Revascularization was performed in 2,773 (46%) patients within 90 days of CMR. Revascularization was more frequent in patients with viable myocardium (88%) than in those with non-viable myocardium (67%, Figure 1). Over a median follow-up of 9 years (interquartile range 7-12 years), 652 patients (11%) died. Using a Cox regression analysis, revascularization was associated with a reduced risk of mortality (HR: 0.73 95% CI: 0.58-0.91, p< 0.001, Figure 2A). Patients with LGE and myocardial viability who underwent revascularization had a similar prognosis to those without LGE (p=0.48). Interestingly, patients who underwent revascularization with myocardial viability had better outcomes than those who underwent revascularization without myocardial viability (p< 0.001, Figure 2B).

Conclusion:

In a large cohort of ICM patients, coronary revascularization was beneficial and was associated with improved survival outcomes. The impact of this revascularization was stronger in patients with myocardial viability assessed by CMR than patients without myocardial viability.