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Coronary revascularization for heart failure with coronary artery disease: A systematic review and meta-analysis of

Antonio Iaconelli1,2, Pierpaolo Pellicori1, Pasquale Dolce3

  • 1School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.

European Journal of Heart Failure
|May 22, 2023
PubMed

Insights

Coronary revascularization may reduce mortality in patients with coronary artery disease and heart failure. However, the benefits are not substantial, and further research is needed to identify optimal treatment strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Coronary artery disease (CAD) is a leading cause of heart failure (HF).
  • The efficacy of coronary revascularization in patients with HF receiving guideline-recommended pharmacological therapy (GRPT) is uncertain.
  • This study systematically reviews randomized controlled trials (RCTs) to evaluate revascularization's impact on morbidity and mortality in HF patients with CAD.

Approach:

  • A systematic review and meta-analysis of RCTs published between January 2001 and November 2022.
  • Searched public databases for studies investigating coronary revascularization effects on morbidity and mortality in chronic HF patients with CAD.
  • Included five RCTs with 2842 participants, focusing on all-cause mortality as the primary outcome.

Key Points:

  • Coronary revascularization showed a statistically significant reduction in all-cause mortality (HR 0.88, p=0.0278) and cardiovascular mortality (HR 0.80, p=0.0024) compared to medical therapy alone.
  • No significant reduction was observed for the composite outcome of HF hospitalization or all-cause mortality (HR 0.87, p=0.0728).
  • The observed survival benefit was neither substantial nor robust, with upper 95% confidence intervals nearing 1.0.

Conclusions:

  • Coronary revascularization offers a statistically significant but not substantial or robust survival benefit for patients with chronic HF and CAD.
  • The lack of blinding in RCTs may introduce bias in reporting outcomes.
  • Further high-quality trials are necessary to determine which specific patient subgroups with HF and CAD benefit most from revascularization via coronary artery bypass grafting or percutaneous coronary intervention.
Abstract

Keywords:
Coronary artery diseaseHeart failureRevascularization

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