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Coronary stenting versus bypass surgery in heart failure patients with preserved ejection fraction

Zeng-ming Xue1, Wei-ju Li, Chang-sheng Ma

  • 1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

Chinese Medical Journal
|May 23, 2012
PubMed

Insights

Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) show similar mortality rates for heart failure with preserved ejection fraction (HFPEF) patients. PCI had more repeat procedures, while CABG had higher in-hospital mortality.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Research

Background:

  • Optimal revascularization strategy for heart failure with preserved ejection fraction (HFPEF) is not well-defined.
  • Coronary artery disease (CAD) frequently coexists with HFPEF, necessitating treatment decisions.
  • Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are potential revascularization options.

Purpose of the Study:

  • To compare the effectiveness of PCI versus CABG in patients diagnosed with both CAD and HFPEF.
  • To evaluate mortality and major adverse cardiac and cerebral vascular events (MACCE) between the two revascularization strategies.

Main Methods:

  • A cohort of 920 patients with CAD and HFPEF (ejection fraction ≥ 50%) were analyzed.
  • Patients underwent either PCI (n=350) or CABG (n=570) between July 2003 and September 2005.
  • Outcomes assessed included mortality, MACCE (death, myocardial infarction, stroke, repeat revascularization) at a median follow-up of 543 days.

Main Results:

  • In-hospital mortality was significantly lower following PCI compared to CABG (0.3% vs. 2.5%, P=0.016).
  • No significant difference in overall mortality rates was observed during follow-up (2.3% vs. 3.5%, P=0.423).
  • PCI patients experienced higher MACCE rates, primarily due to increased repeat revascularization (13.4% vs. 4.0%, P<0.001).

Conclusions:

  • PCI and CABG demonstrate comparable long-term mortality outcomes in patients with CAD and HFPEF.
  • PCI is associated with a higher incidence of repeat revascularization compared to CABG.
  • Age, NYHA class, and chronic total occlusion are independent predictors of mortality in this patient group.
Abstract

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