Jacob Abdaem, Dina Labib, Rhys Beaudry, Augustine Amakiri, Steven Dykstra, Yuanchao Feng, Melanie King, Jacqueline Flewitt, Danielle A. Southern, Matthew T. James, Stephen Wilton, Carmen Lydell, Andrew G. Howarth, Bryan J. Har, James White, Miller, Robert E., Jr.
BACKGROUND: Viability testing is frequently used in patients with ischemic cardiomyopathy (ICM). However, its role in guiding revascularization decisions remains unclear. OBJECTIVES: This study aimed to evaluate the associations between a novel, segmentally registered viability and vascular jeopardy score and mortality following revascularization. METHODS: The study included patients with ICM, defined as obstructive coronary artery disease and LVEF <50%, undergoing cardiac magnetic resonance and invasive coronary angiography between 2015 and 2022. Segmental viability was defined as scar transmurality ≤50% detected by cardiac magnetic resonance. Spatially matched distributions of vascular perfusion jeopardy were established at the time of angiography by using a patient-specific coronary anatomy tree and lesion reporting algorithm. Interactions between viability extent, coronary artery disease severity, the novel marker of jeopardized but viable myocardium, and early revascularization were assessed using propensity score-adjusted time-to-event models for mortality. RESULTS: Of 941 patients (mean age: 65 years; 81% male), 193 underwent early revascularization. During a median follow-up of 4.8 years, 168 deaths occurred. There were no interactions between the number of viable segments and revascularization (interaction HR: 1.09; P = 0.211) or between the Duke Jeopardy Score and revascularization (interaction HR: 0.93; P = 0.245) with respect to future mortality. However, a significant interaction was identified for the number of jeopardized but viable segments (interaction HR: 0.91; P = 0.008). Patients with ≥3 jeopardized but viable segments experienced significantly lower mortality following early revascularization (propensity score-adjusted HR: 0.55; P = 0.015). CONCLUSIONS: Patient-specific coronary tree-based reporting to define jeopardized but viable myocardium accurately is clinically feasible and identifies ICM patients who experience lower mortality from early revascularization.