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Revascularization in severe left ventricular dysfunction: outcome comparison of drug-eluting stent implantation
Giuseppe Gioia1, William Matthai, Karen Gillin
1Atlantic City Medical Center, Pomona, NJ 08240, USA. giuseppe.gioia@atlanticare.org
Insights
Drug-eluting stent (DES) implantation and coronary artery bypass grafting (CABG) show similar long-term survival for patients with severe left ventricular dysfunction. Both revascularization methods offer comparable rates of major adverse cardiac events, making DES a viable option for this high-risk group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Revascularization significantly benefits patients with severe left ventricular (LV) dysfunction.
- Optimal revascularization strategy remains uncertain for this high-risk patient population.
Purpose of the Study:
- To compare the outcomes of drug-eluting stent (DES) implantation versus coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy and severe LV dysfunction.
Main Methods:
- A cohort of 220 patients with LV ejection fraction ≤35% underwent either DES implantation (n=128) or CABG (n=92).
- Exclusion criteria included acute ST-elevation myocardial infarction (STEMI).
- Primary endpoint was all-cause mortality; secondary endpoint was a composite of major cardiac adverse events (MACCE).
Main Results:
- At 2-year follow-up, both groups exhibited similar survival rates (83%) and MACCE-free survival (DES: 76%, CABG: 79%).
- CABG patients showed a greater improvement in NYHA class.
- 30-day mortality was significantly lower in the DES group (P=0.04).
Conclusions:
- DES implantation provides comparable long-term mortality and MACCE rates to CABG in selected high-risk patients with severe LV dysfunction.
- DES represents a viable alternative revascularization strategy for this patient group.
Objective:
We compared the outcome of drug eluting stent (DES) implantation (Sirolimus or Paclitaxel) in patients with ischemic cardiomyopathy and severe left ventricular (LV) dysfunction with the outcome of a similar group of patients undergoing coronary artery by-pass grafting (CABG).
Background:
Revascularization provides long-term benefits in patients with severe LV dysfunction. However the modality to achieve it is still unsettled in this high risk group of patients.
Methods:
Two-hundred-twenty patients (20% women) with severe LV dysfunction (LV Ejection Fraction
Results:
Mean follow-up was 15 +/- 9 months. No differences were noted in age (69 +/- 10 years vs. 68 +/- 10 years, P = NS), LVEF (28 +/- 6 vs. 27 +/- 8, P = NS) history of diabetes (48% vs. 45%, P = NS), congestive heart failure (47% vs. 37%, P = NS) or MI (60% vs. 50%, P = NS) between the DES and CABG groups. The NYHA class was also similar between the two groups (2.6 +/- 0.9 vs. 2.7 +/- 0.8). More patients in DES group had previous CABG (24% vs. 7%. P = 0.001). Patients undergoing CABG had a greater number of vessel disease (2.8 +/- 0.5 vs. 2.3 +/- 0.7, P = 0.001) and received a mean of 3.0 +/- 0.8 graft per patient. Most of the CABG patients had a left internal mammary artery (83%) graft and 24% had off-pump surgery. The DES group had 1.3 artery/patient treated and 1.3 stents were implanted per artery. During the follow-up there were a total of 20 deaths of which three were cancer related (two in DES group and one in the CABG group). Ten deaths (8%) occurred in the DES group and 10 (11%) in the CABG group (P = NS by log-rank test). The 30-day mortality was significantly greater in patients undergoing CABG than DES (five patients in the CABG vs. only one patient in DES group, P = 0.04). At 6 months there was only a trend toward better survival in DES group (97% vs. 93%, P = 0.2). At 2 years follow-up however both groups had the same survival probability from death (83% in both groups). The 2 years MACCE free survival rate was 76% in DES group and 79% in the CABG cohort (P = NS by log rank test). Eight (6%) DES patients needed additional PCI in nontarget vessel during follow-up. The magnitude of NYHA class improvement was greater for the CABG than DES patients (0.9 vs. 1.5, P = 0.01).
Conclusion:
In selected high risk patients with severe LV dysfunction revascularization with DES implantation offers comparable long term mortality and MACCE rate to CABG patients.
