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Coronary revascularization for patients with severe left ventricular dysfunction

Jeevan Nagendran1, Colleen M Norris, Michelle M Graham

  • 1Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

The Annals of Thoracic Surgery
|August 24, 2013
PubMed

Insights

Coronary artery bypass graft surgery (CABG) offers better survival and fewer repeat procedures than percutaneous coronary intervention (PCI) for patients with coronary artery disease and severe left ventricular dysfunction. This finding aids in managing complex cardiac patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Randomized trials define coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) efficacy for coronary artery disease.
  • Patients with severe left ventricular dysfunction (ejection fraction <35%) are underrepresented in trials, leaving management unclear.
  • This study compares CABG and PCI outcomes in patients with coronary artery disease and left ventricular dysfunction.

Purpose of the Study:

  • To compare the long-term outcomes of CABG versus PCI in patients with coronary artery disease and severe left ventricular dysfunction.
  • To evaluate differences in survival rates and need for repeat revascularization between the two procedures.

Main Methods:

  • Utilized the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database.
  • Identified 2925 patients with coronary artery disease and left ventricular dysfunction undergoing CABG (n=1,326) or PCI (n=1,599) between 1995 and 2008.
  • Propensity matching was used to create comparable subgroups for analysis.

Main Results:

  • CABG was associated with significantly lower rates of repeat revascularization compared to PCI.
  • CABG demonstrated better survival rates at 1, 5, 10, and 15 years post-procedure.
  • Independent predictors of poor long-term survival included age, renal failure, heart failure, diabetes, peripheral vascular disease, prior myocardial infarction, left main coronary artery disease, and prior CABG.

Conclusions:

  • CABG is associated with improved survival and reduced repeat revascularization rates compared to PCI in patients with coronary artery disease and left ventricular dysfunction.
  • Findings are adjusted for baseline risk profile differences.
  • Further research is needed to explore factors influencing revascularization modality choice in this complex patient group.
Abstract

Keywords:
23CABGCADCIDESEFHRLVDPCIconfidence intervalcoronary artery bypass graft surgerycoronary artery diseasedrug-eluting stentejection fractionhazard ratioleft ventricular dysfunctionpercutaneous coronary intervention

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