Long-term Outcomes in Patients With Severely Reduced Left Ventricular Ejection Fraction Undergoing Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting

Sun, Louise Y.; Gaudino, Mario; Chen, Robert J; Eddeen, Anan Bader; Ruel, Marc

doi:10.1001/jamacardio.2020.0239

Cited by 117 publications

(117 citation statements)

References 41 publications

(62 reference statements)

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“…Other comorbidities were identified using Discharge Abstract Database, Same Day Surgery and Ontario Health Insurance Plan databases based on International Classification of Diseases 10th Revision codes within 5 years of HF diagnosis, using previously described methods. [17][18][19][20][21][22][23][24][25][26][27][28][29] Frailty was identified using the Johns Hopkins Adjusted Clinical Groups frailtydefining diagnoses indicator, which is an instrument designed and validated for research of frailty-related outcomes and resource utilisation using administrative data. 25 28 30-34 Statistical analysis Analyses were stratified by sex.…”

Section: Covariatesmentioning

confidence: 99%

Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

et al. 2020

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ObjectivesTo examine the temporal trends in mortality and heart failure (HF) hospitalisation in ambulatory patients following a new diagnosis of HF.DesignRetrospective cohort studySettingOutpatientParticipantsOntario residents who were diagnosed with HF in an outpatient setting between 1994 and 2013.Primary and secondary outcome measuresThe primary outcome was all-cause mortality within 1 year of diagnosis and the secondary outcome was HF hospitalisation within 1 year. Risks of mortality and hospitalisation were calculated using the Kaplan-Meier method and the relative hazard of death was assessed using multivariable Cox proportional hazard models.ResultsA total of 352 329 patients were studied (50% female). During the study period, there was a greater decline in age standardised 1-year mortality rates (AMR) in men (33%) than in women (19%). Specifically, female AMR at 1 year was 10.4% (95% CI 9.1% to 12.0%) in 1994 and 8.5% (95% CI 7.5% to 9.5%) in 2013, and male AMR at 1 year was 12.3% (95% CI 11.1% to 13.7%) in 1994 and 8.3% (95% CI 7.5% to 9.1%) in 2013. Conversely, age standardised HF hospitalisation rates declined in men (11.4% (95% CI 10.1% to 12.9%) in 1994 and 9.1% (95% CI 8.2% to 10.1%) in 2013) but remained unchanged in women (9.7% (95% CI 8.3% to 11.3%) in 1994 and 9.8% (95% CI 8.6% to 11.0%) in 2013).ConclusionAmong patients with HF over a 20-year period, there was a greater improvement in the prognosis of men compared with women. Further research should focus on the determinants of this disparity and ways to reduce this gap in outcomes.

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Section: Covariatesmentioning

confidence: 99%

Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

et al. 2020

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“…Several studies have clarified that CABG improves the clinical outcome of patients with reduced LVEF compared with PCI. 9,10,13,19 The meta-analysis by Wolff et al also reported Figure 4 The results of propensity score-matched study subgroup analysis. CABG, coronary artery bypass grafting; CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; MI, myocardial infarction; PCI, percutaneous coronary intervention; RR, repeat revascularization.…”

Section: Discussionmentioning

confidence: 95%

“…published their work in 2017, many important studies were published; for example, Sun et al . published the largest propensity score‐matched cohort study to date 9 . This study reported that CABG was associated with a higher stroke risk than that observed with PCI for patients with severely reduced ejection fraction.…”

Section: Discussionmentioning

confidence: 99%

“…The vagueness of their guidelines reflects the lack of relevant evidence. Several cohort studies have reported that coronary artery bypass grafting (CABG) is associated with better prognosis compared with percutaneous coronary interventions (PCIs); however, these findings have not been confirmed in clinical trials 9–11 . Cohort studies are insufficient to confirm the superiority of CABG over PCI.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Aims This meta-analysis aimed to determine whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) should be preferred in patients with severely reduced left ventricular (LV) ejection fraction. Methods and results We searched the PubMed, EMBASE, and Cochrane Library databases from the conception of the databases till 1 May 2020 for studies on patients with severely reduced LV ejection fraction undergoing CABG and PCI. The primary clinical endpoints were 30 day and long-term mortalities. The secondary endpoints were 30 day and long-term incidences of myocardial infarction (MI) and stroke, long-term cardiovascular mortality, and repeat revascularization. Eighteen studies involving 11 686 patients were analysed. Compared with PCI, CABG had lower long-term mortality [hazard ratio (HR): 0.70, 95%

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“…Therapeutic decisions are challenging for patients with advanced cardiovascular disease, because there is a paucity of evidence to support patient-centered outcomes in this group. 1,2 Traditional cardiovascular trials have sometimes been termed tombstone trials 3 because of their focus on major adverse cardiac events and death. However, a prior survey 2 of cardiovascular patients found that important outcomes identified by patients were very different from those used in traditional trials.…”

Section: Introductionmentioning

confidence: 99%

Derivation of Patient-Defined Adverse Cardiovascular and Noncardiovascular Events Through a Modified Delphi Process

et al. 2021

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Long-term Outcomes in Patients With Severely Reduced Left Ventricular Ejection Fraction Undergoing Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting

Cited by 117 publications

References 41 publications

Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

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

Derivation of Patient-Defined Adverse Cardiovascular and Noncardiovascular Events Through a Modified Delphi Process

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