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Percutaneous coronary intervention versus coronary artery bypass grafting among patients with left ventricular

Vikash Jaiswal1,2, Song Peng Ang3, Abhigan Babu Shrestha4

  • 1JCCR Cardiology Research, Varanasi.

Annals of Medicine and Surgery (2012)
|June 26, 2023
PubMed

Insights

Coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention (PCI) for patients with ischemic left ventricular systolic dysfunction (LVSD). CABG reduces risks of mortality, repeat procedures, and myocardial infarction in LVSD patients.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Current guidelines support coronary artery bypass grafting (CABG) over medical therapy.
  • Optimal revascularization strategy for patients with ischemic left ventricular systolic dysfunction (LVSD) remains under investigation.
  • Limited data exists comparing CABG and percutaneous coronary intervention (PCI) in LVSD patients.

Purpose of the Study:

  • To evaluate and compare clinical outcomes of PCI versus CABG in patients with LVSD.
  • To determine the optimal revascularization strategy for LVSD patients based on existing literature.

Main Methods:

  • Systematic literature search conducted on PubMed, Embase, Scopus, and Cochrane Libraries until November 2022.
  • Meta-analysis of 10 studies including 13,324 patients with LVSD.
  • Outcomes reported as pooled odds ratios (OR) with 95% confidence intervals (CI) using STATA.

Main Results:

  • PCI group showed higher odds of all-cause mortality (OR 1.15, P=0.03), repeat revascularization (OR 3.57, P<0.001), and myocardial infarction (MI) (OR 1.92, P=0.048) compared to CABG.
  • Incidence of cardiovascular mortality, stroke, major adverse cardiovascular and cerebrovascular events, and ventricular tachycardia were comparable between PCI and CABG.
  • Mean follow-up duration was 3.75 years; common comorbidities included hypertension and diabetes mellitus.

Conclusions:

  • Coronary artery bypass grafting (CABG) demonstrates superiority over percutaneous coronary intervention (PCI) for patients with left ventricular systolic dysfunction (LVSD).
  • CABG is associated with significantly lower risks of all-cause mortality, repeat revascularization, and myocardial infarction in LVSD patients.
  • The findings support CABG as the preferred revascularization strategy for patients with LVSD.

Keywords:
acute coronary syndromecardiomyopathycoronary artery bypass graftingischemiapercutaneous coronary interventionsrevascularization

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