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Author Spotlight: Enhancing Coronary Artery Revascularization
05:25

Author Spotlight: Enhancing Coronary Artery Revascularization

Published on: September 15, 2023

945

[Different revascularization strategies for patients with coronary artery disease complicating reduced ejection

Y Lyu1, J H Liu1, S P Wang1

  • 1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

Zhonghua Yi Xue Za Zhi
|July 18, 2021
PubMed

Insights

Percutaneous coronary intervention (PCI) is a viable alternative to coronary artery bypass grafting (CABG) for patients with coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF). Long-term survival rates are comparable, suggesting PCI can be considered for patients with left ventricular dysfunction.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Management

Background:

  • Coronary artery disease (CAD) often coexists with heart failure with reduced ejection fraction (HFrEF).
  • Revascularization strategies aim to improve outcomes in these complex patients.
  • Comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is crucial for optimizing treatment.

Purpose of the Study:

  • To compare the short- and long-term outcomes of CAD patients with HFrEF treated with PCI versus CABG.
  • To evaluate the impact of revascularization strategy on left ventricular function and major adverse cardiovascular and cerebrovascular events (MACCE).

Main Methods:

  • Retrospective analysis of 1,813 CAD patients with HFrEF who underwent successful PCI (n=687) or CABG (n=1,126) between 2005 and 2014.
  • Comparison of baseline characteristics, left ventricular ejection fraction (LVEF) changes, and MACCE over a mean follow-up of 3.1 years.
  • Multivariable adjustment was used to analyze three-year outcomes, including all-cause mortality, cardiac death, stroke, and repeat revascularization.

Main Results:

  • No significant difference in LVEF improvement was observed between PCI and CABG groups at 3 months, 1 year, or 3 years.
  • After multivariable adjustment, three-year risks of all-cause mortality and cardiac death were not statistically significant between groups.
  • The CABG group had a higher rate of stroke but a lower rate of repeat revascularization compared to the PCI group.

Conclusions:

  • Percutaneous coronary intervention (PCI) is non-inferior to coronary artery bypass grafting (CABG) in terms of long-term survival for CAD patients with HFrEF.
  • PCI should be considered a viable alternative revascularization strategy for patients with left ventricular dysfunction.
  • The choice of revascularization strategy may depend on specific patient factors and desired endpoints, such as stroke risk and need for repeat procedures.

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