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Updated: Dec 5, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Percutaneous coronary intervention versus coronary artery bypass grafting in patients with reduced ejection fraction
Valentino Bianco1, Arman Kilic2, Suresh Mulukutla3
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
Insights
Coronary artery bypass grafting (CABG) significantly improves long-term survival and reduces major adverse cardiac and cerebrovascular events (MACCE) compared to percutaneous coronary intervention (PCI) in patients with reduced ejection fraction. CABG also leads to fewer hospital readmissions and repeat revascularization procedures.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Reduced ejection fraction (EF <50%) poses significant risks for patients undergoing coronary revascularization.
- Choosing between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is critical for this high-risk population.
Purpose of the Study:
- To compare the long-term outcomes of PCI versus CABG in patients with reduced ejection fraction.
- To evaluate differences in survival, readmission rates, and major adverse cardiac and cerebrovascular events (MACCE).
Main Methods:
- Retrospective analysis of 2000 patients (2011-2018) with EF <50% undergoing CABG or PCI.
- Propensity score matching (1:1) to control for baseline characteristics.
- Primary outcomes included long-term survival, readmission, and MACCE.
Main Results:
- CABG cohort (n=324) showed significantly lower overall mortality (21.3% vs 37.4%) compared to PCI cohort (n=324) over a median follow-up of 3.23 years.
- CABG was associated with significantly lower rates of total readmissions (12.9% vs 24.1%), cardiac readmissions (11.1% vs 20.4%), myocardial infarction (1.8% vs 7.7%), MACCE (23.8% vs 41.4%), and repeat revascularization (2.6% vs 6.5%).
- Freedom from MACCE at 5 years was significantly higher for CABG (74.0%) versus PCI (54.5%).
Conclusions:
- Coronary artery bypass grafting (CABG) offers superior long-term survival and reduced MACCE compared to percutaneous coronary intervention (PCI) in patients with reduced ejection fraction.
- CABG is associated with fewer hospital readmissions and repeat revascularization procedures.
- CABG should be strongly considered for patients with reduced ejection fraction requiring coronary revascularization.
Objective:
The aim of this study was to evaluate comparative outcomes for percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with reduced ejection fraction.
Methods:
All patients from the University of Pittsburgh Medical Center from 2011 to 2018 who had reduced preoperative ejection fraction (<50%) and underwent CABG or PCI for coronary revascularization were included in this study. Patients were risk-adjusted with propensity matching (1:1) and primary outcomes included long-term survival, readmission, and major adverse cardiac and cerebrovascular events (MACCE).
Results:
A total of 2000 patients were included in the current study, consisting of CABG (n = 1553) and PCI (n = 447) cohorts with a mean ejection fraction of 35% ± 9.53%. Propensity matching yielded a 1:1 match with 324 patients in each cohort, controlling for all baseline characteristics. Thirty-day mortality was similar for PCI versus CABG (6.2% vs 4.9%; P = .49). Overall mortality over the study follow-up period (median, 3.23 years; range, 1.83-4.98 years) was significantly higher for the PCI cohort (37.4% vs 21.3%; P < .001). Total hospital readmissions (24.1% vs 12.9%; P = .001), cardiac readmissions (20.4% vs 11.1%; P = .001), myocardial infarction event (7.7% vs 1.8%; P = .001), MACCE (41.4% vs 23.8%; P < .001), and repeat revascularization (6.5% vs 2.6%; P = .02) occurred more frequently in the PCI cohort. Freedom from MACCE at 1 year (74.4% vs 87.0%; P < .001) and 5 years (54.5% vs 74.0%; P < .001) was significantly lower for the PCI cohort. On multivariable cox regression analysis, CABG (hazard ratio, 0.57; 95% confidence interval, 0.44-0.73; P < .001) was significantly associated with improved survival. Prior liver disease, dialysis, diabetes, and peripheral artery disease were the most significant predictors of mortality. The cumulative incidence of hospital readmission was lower for the CABG cohort (hazard ratio, 0.51; 95% confidence interval, 0.37-0.71; P < .001). Multivariable cox regression for MACCE (hazard ratio, 0.48; 95% confidence interval, 0.39-0.58; P < .001) showed significantly fewer events for the CABG cohort.
Conclusions:
Patients with reduced ejection fraction who underwent CABG had significantly improved survival, lower MACCE, and fewer repeat revascularization procedures compared with patients who underwent PCI.
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