Panza JA, Ellis AM, Al-Khalidi HR, et al. – In a cohort of 601 patients who had coronary artery disease, were amenable to coronary artery bypass grafting (CABG), and had a left ventricular ejection fraction of ≤ 35%, researchers determined whether myocardial viability was related to a long-term advantage of CABG. CABG plus medical therapy was related to a lower incidence of death from any cause vs medical therapy alone (182 deaths among 298 patients in the CABG group vs 209 deaths among 303 patients in the medical therapy group). Nevertheless, there was no important interaction between the presence or absence of myocardial viability and the advantageous impact of CABG plus medical therapy over medical therapy alone. Only among patients with myocardial viability was a rise in left ventricular ejection fraction noted, regardless of treatment assignment. No relationship between variations in left ventricular ejection fraction and subsequent death was observed. Thus, in patients with ischemic cardiomyopathy, the concept that myocardial viability is related to a long-term advantage of CABG was not supported. Moreover, the presence of viable myocardium was related to improvement in left ventricular systolic function, despite the treatment; however, such improvement was not associated with long-term survival.