Treatment strategies in ischaemic left ventricular dysfunction: a network meta-analysis

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Optimal revascularization for ischaemic left ventricular systolic dysfunction (iLVSD) is debated.
• Percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and medical therapy (MT) are treatment options.

Purpose of the Study:

• To compare the effectiveness of PCI, CABG, and MT in patients with iLVSD.
• To determine the best revascularization strategy for improving patient outcomes.

Main Methods:

• A frequentist network meta-analysis was conducted.
• Included 23 studies (23,633 patients), comprising 4 randomized controlled trials and observational studies.
• Primary outcome was all-cause mortality; secondary outcomes included cardiac death, stroke, myocardial infarction (MI), and repeat revascularization (RR).

Main Results:

• CABG demonstrated superior outcomes for mortality, cardiac death, MI, and RR compared to both PCI and MT.
• PCI was associated with lower cardiac death than MT.
• MT was linked to the lowest incidence of stroke.

Conclusions:

• CABG appears to be the most effective therapy for iLVSD, based primarily on observational data.
• High-quality randomized controlled trials directly comparing CABG and PCI in iLVSD patients are essential for definitive conclusions.