Comparison of coronary artery bypass grafting and percutaneous coronary intervention in patients with heart failure with reduced ejection fraction and multivessel coronary artery disease

Abstract

AimsTo compare coronary artery bypass grafting (CABG) with percutaneous coronary interventions (PCI) in patients with heart failure with reduced ejection fraction (HFrEF) and multivessel coronary artery disease.Methods1213 patients were selected from institutional databases, 761 and 452 in CABG and PCI group respectively. Only the subjects with left ventricle ejection fraction ≤ 35% and multivessel coronary artery disease were included to the study. The primary outcome measure was long-term all-cause death, the secondary outcomes were recurrent myocardial infarction, urgent repeat revascularization and stroke. Propensity Score-Based Adjusted Survival Curves were used for revascularization methods comparison.ResultsSurvival rates were similar in both groups (HR, 0.91; 95% CI, 0.65-1.28; p=0.59). Recurrent myocardial infarction was observed significantly less often in the CABG group (HR, 0.44; 95% CI, 0.26-0.74; p=0.002). Repeat urgent revascularization was less frequent in the CABG group (HR, 0.50; 95% CI, 0.30-0.84; p=0.008). The rate of stroke did not differ between the groups (HR, 1.17; 95% CI, 0.62-2.22; p=0.62).ConclusionsIn patients with HFrEF and multivessel CAD revascularization both with CABG and PCI resulted in similar survival rates. PCI is associated with increased risk of recurrent MI and urgent repeat revascularization, whereas the risk of stroke is similar in both methods.

Short‐term and long‐term outcomes of revascularization interventions for patients with severely reduced left ventricular ejection fraction: a meta‐analysis

“…All 18 studies reported the long‐term mortality of patients, and eight studies involving 11 686 patients reported 30 day mortality 9,11,17,19,22,27,28,30 . There was no statistically significant difference in the 30 day mortality between CABG and PCI (HR: 1.18, 95% CI: 0.89–1.56, P = 0.25, I 2 : 34.1%; Figure , Supporting Information, ).…”

“…Four studies involving 8240 patients reported the 30 day incidence of MI 9,17,19,28 . There was no statistically significant difference between CABG and PCI with respect to the 30 day incidence of MI (HR: 0.42, 95% CI: 0.16–1.11, P = 0.08, I 2 : 70.6%; Figure , Supporting Information, Figure ).…”

“…A statistically significant decrease in the long‐term CVD‐related mortality was only observed for CABG (HR: 0.60, 95% CI: 0.43–0.85, P < 0.01, I 2 : 59.9%; Figure , Supporting Information, Figure ). A total of nine studies involving 11 522 patients reported the long‐term incidence of MI 9,10,17–20,27,28,30 . A statistically significant decrease in the reduction in the long‐term incidence of MI was only observed for CABG (HR: 0.51, 95% CI: 0.36–0.72, P < 0.01, I 2 : 62.6%; Figure , Supporting Information, Figure ).…”

“…We selected 35 studies for a full review. After applying the inclusion and exclusion criteria, 18 studies published between 2002 and April 2020 were finally analysed 9–11,16–30 . These studies included two randomized controlled trials involving 139 patients, 26,29 a case–control study involving 107 patients, 28 and 16 registry studies involving 16 940 patients 9–11,16–25,27,29,30 …”

“…After applying the inclusion and exclusion criteria, 18 studies published between 2002 and April 2020 were finally analysed. [9][10][11][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] These studies included two randomized controlled trials involving 139 patients, 26,29 a case-control study involving 107 patients, 28 and 16 registry studies involving 16 940 patients. [9][10][11][16][17][18][19][20][21][22][23][24][25]27,29,30 The baseline characteristics of the included studies are presented in Table 1, and the quality assessment is presented in Supporting Information , Table S1.…”