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Preferred Revascularization Strategies in Patients with Ischemic Heart Failure: A Meta-Analysis

Jie Xiao1,2, Fen Xu1, Chuan-Lei Yang3

  • 1Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.

Current Medical Science
|October 21, 2018
PubMed

Insights

Coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention (PCI) for treating ischemic heart failure, reducing long-term mortality, myocardial infarction, and repeat revascularization. This finding offers clarity on optimal revascularization strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Ischemic heart failure management often involves coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).
  • Optimal revascularization strategy for severe ischemic heart failure remains uncertain.

Purpose of the Study:

  • To compare the efficacy of CABG versus PCI in treating patients with severe ischemic heart failure.
  • To determine the optimal revascularization strategy based on long-term outcomes.

Main Methods:

  • A meta-analysis was conducted using studies from PubMed, EMBASE, Google Scholar, and CENTRAL.
  • Twelve studies involving 9248 patients (4872 CABG, 4376 PCI) were analyzed.
  • Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS).

Main Results:

  • Coronary artery bypass grafting (CABG) demonstrated a statistically significant reduction in long-term mortality compared to percutaneous coronary intervention (PCI) (HR=0.83).
  • CABG also showed significant advantages in reducing the incidence of myocardial infarction (HR=0.51) and repeat revascularization (HR=0.40).
  • Low heterogeneity was observed for mortality and myocardial infarction outcomes, while repeat revascularization showed moderate heterogeneity.

Conclusions:

  • Coronary artery bypass grafting (CABG) appears to be a more advantageous treatment strategy than percutaneous coronary intervention (PCI) for patients with ischemic heart failure.
  • The findings suggest CABG offers superior long-term clinical outcomes in this patient population.

Keywords:
coronary artery bypass graftingcoronary artery diseaseischemic heart failureleft ventricular ejection fractionpercutaneous coronary intervention

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