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Angiographic Complete versus Clinical Selective Incomplete Percutaneous Revascularization in Heart Failure Patients
Chieh-Yu Chang1, Chun-Chi Chen1, I-Chang Hsieh1
1Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Address: No. 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan.
Insights
For heart failure patients with multivessel disease, selective incomplete revascularization (IR) during PCI offers similar long-term outcomes to complete revascularization (CR). Failing CR significantly increases major adverse cardiac events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Research
Background:
- Multivessel disease (MVD) in heart failure (HF) patients often necessitates percutaneous coronary intervention (PCI).
- Complete revascularization (CR) aims to improve prognosis but is not always feasible and carries risks in HF patients with MVD.
- The long-term outcomes of selective incomplete revascularization (IR) in this high-risk population remain uncertain.
Purpose of the Study:
- To compare the 5-year major adverse cardiac events (MACEs) of selective IR versus successful angiographic CR in patients with HF and MVD undergoing PCI.
- To evaluate the impact of failed CR on long-term outcomes in this patient cohort.
Main Methods:
- A prospective study enrolled 600 patients with HF and MVD undergoing PCI.
- Major adverse cardiac events (MACEs) were defined as a composite of recurrent myocardial infarction, any revascularization, and all-cause mortality.
- Outcomes were assessed at a 5-year follow-up period.
Main Results:
- No significant difference in 5-year MACEs was observed between selective IR and successful CR groups.
- Patients who failed CR experienced a significantly higher incidence of 5-year MACEs (46.4%) compared to selective IR (27.7%) and successful CR (27.8%).
- The risk of MACEs was 2.53-fold higher in patients with failed CR.
Conclusions:
- Long-term outcomes of selective IR are comparable to successful angiographic CR in HF patients with MVD.
- Failed CR is associated with substantially worse long-term outcomes.
- Comprehensive pre-procedural planning is crucial for PCI in HF patients with MVD to optimize revascularization strategies.
Background:
Patients with multivessel disease (MVD) often pursue complete revascularization (CR) during percutaneous coronary intervention (PCI) to improve prognosis. However, angiographic CR is not always feasible and is associated with some procedure-related complications in heart failure (HF) patients with MVD. Clinical selective incomplete revascularization (IR) may be reasonable for these high-risk patients, but its role in long-term outcomes remains uncertain.
Methods:
Six hundred patients with HF and MVD submitted to PCI were enrolled. Major adverse cardiac events (MACEs) were defined as a composite of recurrent myocardial infarction, any revascularization, and all-cause mortality at 5 years.
Results:
During a mean follow-up period of 3.7 ± 1.9 years, there was no significant difference in 5-year MACEs between selective IR and successful angiographic CR in HF patients with MVD. However, patients who failed CR had a significantly greater incidence of 5-year MACEs than those in the other two groups (failed CR: 46.4% vs. selective IR: 27.7% vs. successful CR: 27.8%, p < 0.001).
Conclusions:
Long-term outcomes of selective IR were comparable with those of successful angiographic CR in HF patients with MVD. However, patients that failed CR showed 2.53-fold increased risk of MACEs compared to patients undergoing either selective IR or successful angiographic CR. A more comprehensive planning strategy should be devised before PCI in HF patients with MVD.
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