Ten-year improved survival in patients with multi-vessel coronary disease and poor left ventricular function...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Patients with multi-vessel coronary artery disease and ejection fraction (EF) < 30% represent a high-risk group for revascularization.
• Limited long-term survival data compares percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) versus surgical revascularization in this population.

Purpose of the Study:

• To compare the long-term (10-year) all-cause mortality between PCI with DES and coronary artery bypass grafting (CABG) in high-risk patients with multi-vessel coronary artery disease and poor left ventricular function (EF < 30%).

Main Methods:

• Retrospective review of 321 patients with EF < 30% undergoing multi-vessel revascularization between January 2005 and December 2015.
• Utilized Cox regression, inverse probability treatment weighting (IPTW), and instrumental variable analyses.
• Stratified surgical patients into on-pump and off-pump CABG groups for comparison with PCI.

Main Results:

• PCI with DES demonstrated significantly higher 10-year all-cause mortality compared to both on-pump CABG (HR=1.86) and off-pump CABG (HR=2.32).
• Instrumental variable analyses confirmed higher mortality with PCI versus on-pump CABG (Δ=13.5%) and off-pump CABG (Δ=16.1%).
• These findings were consistent across different analytical methods, including IPTW.

Conclusions:

• Surgical revascularization, with a preference for off-pump CABG, is associated with superior long-term survival compared to PCI with second-generation DES in patients with multi-vessel coronary artery disease and severely impaired left ventricular function.
• Randomized controlled trials are warranted to further investigate these outcomes in this specific patient cohort.