Complete percutaneous revascularisation feasibility in ischaemic heart failure is related to improved outcomes: insights from the COMMIT-HF registry

Abstract

A b s t r a c tBackground and aim: Heart failure (HF) is a major cause of death in cardiovascular disease. In a post-STICH landscape, we lack data on the role of percutaneous coronary intervention (PCI) in systolic HF patients. Complete revascularisation remains a key unanswered question in ischaemic HF. Methods:The COMMIT-HF is an ongoing systolic HF registry (inclusion criteria: HF with left ventricular ejection fraction ≤ 35%, exclusion: acute coronary syndrome). A total of 1798 patients were enrolled. A group of patients with multi-vessel coronary artery disease qualified for PCI were selected and divided into complete (n = 188) and incomplete revascularisation (n = 159) groups. Completeness of revascularisation was defined as successful PCI of every angiographically significant lesion in all arteries with a diameter of ≥ 2 mm without a patent surgical graft. Patients were followed up for a period of at least 12 months with all-cause mortality defined as the primary endpoint. Results:The study groups showed no significant differences in clinical status and echocardiographic parameters, with a lower comorbidity rate in the complete revascularisation group. Procedural characteristics were comparable. There were no significant differences in complication rates. All-cause mortality was significantly lower in the complete revascularisation group after 12-months (6.4% vs. 20.1%, p < 0.001). Multivariate analysis confirmed that achievement of complete revascularisation was an independent factor improving survival (HR 0.39; 95% CI 0.18-0.81, p = 0.01). Conclusions:Percutaneous coronary intervention can be a safe and feasible method of revascularisation in ischaemic HF. Achievement of complete revascularisation with PCI was related to improved outcomes in the analysed patient population.

Two-­year prognosis of patients hospitalized for decompensated heart failure in a district general hospital

“…Previous studies have reported ischemic heart disease as the most common cause of HF exac erbation requiring hospitalization, 1,19 affecting about 70% of the European population, 20 includ ing two thirds of patients with reduced LVEF. 21 Our results are in line with these statistics. Of note, the percentage of patients with a history of myocardial infarction was higher among those hospitalized between 2010 and 2011 (52%) com pared with those hospitalized in the years 2016 to 2017 (41%; P = 0.03).…”

Risk factors for poor prognosis in heart failure with particular attention to the elderly population

“…In the presented project, almost 3 out of 4 patients from the elderly subgroup had CAD diagnosis. Additionally, these patients underwent revascularization more frequently, which is in agreement with the general trend observed in cardiology: the elderly may benefit more from invasive treatment, despite a higher periprocedural risk [27][28]. The general percentage of revascularized patients is surprisingly low in the study group with the diagnosis of CAD, although not every CAD patient requires invasive treatment.…”

Temporal trends in secondary prevention in myocardial infarction patients discharged with left ventricular systolic dysfunction in Poland

“…Increasing the prevalence of complete revascularisation is a potential tool for the improvement of outcomes in this population, as shown in previous studies. 30,31 Although the percentage of ICD or CRT-D implantations within one year post-discharge increased significantly over the period analysed, it remained low. Even considering potential improvement or stabilisation of LVEF and/or lack of HF symptom development in subsequent observations, this is a worrisome result from an analysis performed in a healthcare system with no procedural or reimbursement-related limitations in performing these procedures.…”

“…Increasing the prevalence of complete revascularisation is a potential tool for the improvement of outcomes in this population, as shown in previous studies. 30,31…”