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Short-term and long-term outcomes of revascularization interventions for patients with severely reduced left

Junyu Pei1, Xiaopu Wang1, Zhenhua Xing1,2

  • 1Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, China.

ESC Heart Failure
|December 4, 2020
PubMed

Insights

Coronary artery bypass grafting (CABG) offers lower long-term mortality for patients with reduced ejection fraction compared to percutaneous coronary intervention (PCI). However, CABG is linked to an increased risk of stroke, particularly long-term.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severely reduced left ventricular (LV) ejection fraction poses significant risks for patients with coronary artery disease.
  • Choosing between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) is critical for this patient group.

Purpose of the Study:

  • To compare the effectiveness of CABG versus PCI in patients with severely reduced LV ejection fraction.
  • To evaluate long-term mortality, myocardial infarction (MI), stroke, and repeat revascularization rates for both procedures.

Main Methods:

  • A meta-analysis of 18 studies involving 11,686 patients.
  • Searched PubMed, EMBASE, and Cochrane Library databases up to May 1, 2020.
  • Primary endpoints: 30-day and long-term mortality. Secondary endpoints: MI, stroke, cardiovascular mortality, and repeat revascularization.

Main Results:

  • CABG demonstrated lower long-term mortality, cardiovascular mortality, MI, and repeat revascularization compared to PCI.
  • No significant difference in 30-day mortality or long-term stroke risk was observed initially.
  • However, CABG was associated with a higher risk of 30-day stroke and, in subgroup analysis, a higher long-term stroke risk.

Conclusions:

  • For patients with severely reduced LV ejection fraction, CABG leads to reduced mortality rates.
  • The benefit of CABG in terms of mortality must be weighed against its associated increased risk of stroke.
Abstract

Keywords:
Coronary artery bypassCoronary artery diseaseHeart failureMeta-analysisStroke

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