Related Experiment Video
Updated: Feb 5, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Coronary artery bypass graft versus percutaneous coronary intervention in acute heart failure
Sang Eun Lee1, Hae-Young Lee2, Hyun-Jai Cho2
1Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Coronary artery bypass graft (CABG) surgery is linked to lower mortality in acute heart failure (AHF) patients compared to percutaneous coronary intervention (PCI). This study highlights CABG as a potentially superior revascularization strategy for AHF.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Acute Heart Failure Management
Background:
- Myocardial ischemia is a primary driver of acute heart failure (AHF).
- Optimal revascularization strategies for AHF remain uncertain.
- Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) are common revascularization methods.
Purpose of the Study:
- To compare the effectiveness of CABG versus PCI in patients experiencing AHF.
- To assess adverse outcomes associated with different revascularization strategies in AHF.
Main Methods:
- Prospective enrollment of 5625 patients in the Korean Acute Heart Failure registry.
- Analysis of 717 patients who underwent CABG or PCI during hospitalization for AHF.
- Propensity score matching was used to compare adverse outcomes including mortality and rehospitalization.
Main Results:
- In the matched cohort (190 patients), CABG showed significantly lower all-cause mortality than PCI (HR 0.57; p=0.033) over 4 years.
- A trend towards reduced rehospitalization for cardiovascular events or HF aggravation was observed with CABG.
- Subgroup analyses indicated better outcomes with CABG in specific patient groups, including elderly, multi-vessel disease, and specific coronary artery lesions.
Conclusions:
- CABG is associated with significantly lower all-cause mortality compared to PCI in AHF patients.
- Further research is needed to establish definitive revascularization guidelines for AHF.
Objective:
Myocardial ischaemia is a leading cause of acute heart failure (AHF). However, optimal revascularisation strategies in AHF are unclear. We aimed to compare two revascularisation strategies, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), in patients with AHF.
Methods:
Among 5625 consecutive patients enrolled prospectively in the Korean Acute Heart Failure registry from March 2011 to February 2014, 717 patients who received CABG or PCI during the index hospitalisation for AHF were included in this analysis. We compared adverse outcomes (death, rehospitalisation for HF aggravation or cardiovascular causes, ischaemic stroke and a composite outcome of death and rehospitalisation for HF aggravation or cardiovascular causes) with the use of propensity score matching.
Results:
For the propensity score-matched cohort with 190 patients, CABG had a lower risk of all-cause mortality than PCI (83 vs 147 deaths per 1000 patient-years; HR 0.57, 95% CI 0.34 to 0.96, p=0.033) during the median follow-up of 4 years. There was also a trend towards lower rates of rehospitalisation due to cardiovascular events or HF aggravation. Subgroup analysis revealed that the adverse outcomes were significantly lower in the CABG group than in PCI group, especially in patients with old age, three-vessel diseases, significant proximal left anterior descending artery disease and those without left main vessel disease or chronic total occlusion.
Conclusions:
Compared with PCI, CABG is associated with significant lower all-cause mortality in patients with AHF. Further studies should evaluate proper revascularisation strategies in AHF.
Clinical Trial Registration:
NCT01389843; Results.
More Related Videos
14:35Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:30Acute Coronary Syndrome I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:26Acute Coronary Syndrome V: Nursing Management
01:30Heart Failure VII: Nursing Interventions
01:27Coronary Artery Disease V: Interprofessional Care