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Temporal Trend in Revascularization for Patients With Ischemic Cardiomyopathy and Multivessel Coronary Artery Disease
Anas H Alzahrani1,2, Sundos Alabbadi1, Shinobu Itagaki3,4
1Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York NY.
Insights
Trends in revascularization for ischemic cardiomyopathy (ICM) show a decline in coronary artery bypass grafting (CABG) and an increase in percutaneous coronary intervention (PCI). Both procedures demonstrated comparable 30-day mortality risks after accounting for revascularization completeness.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Current guidelines recommend revascularization for ischemic cardiomyopathy (ICM).
- Limited data exists on trends and outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in ICM patients with multivessel coronary artery disease.
- Understanding these trends is crucial for optimizing patient care.
Purpose of the Study:
- To analyze the trends in CABG and PCI utilization for multivessel coronary artery disease in patients with ICM.
- To compare the 30-day mortality rates between CABG and PCI in this patient population.
- To identify factors influencing the choice and outcomes of revascularization strategies.
Main Methods:
- Analysis of 8083 patients with ICM undergoing CABG or PCI for multivessel coronary artery disease from 2007-2018 using New Jersey state registries.
- Joinpoint regression to assess annual percentage changes in revascularization trends.
- Multivariable logistic regression to evaluate predictors of 30-day mortality.
Main Results:
- CABG procedures declined from 2007-2011, followed by stabilization; PCI trends remained stable initially then increased significantly.
- Procedure dominance varied based on coronary artery anatomy: PCI dominated in left anterior descending artery plus other stenosis, while CABG predominated in left main plus other stenosis.
- Initial 30-day mortality was higher with PCI, but this difference disappeared after adjusting for completeness of revascularization.
Conclusions:
- Revascularization patterns for ICM patients with multivessel coronary artery disease have evolved, with significant shifts in CABG and PCI utilization.
- CABG and PCI offer comparable 30-day risk-adjusted mortality outcomes when revascularization completeness is considered.
- These findings have implications for treatment guidelines and clinical decision-making in ICM management.
Background:
Current guidelines recommend revascularization in patients with ischemic cardiomyopathy (ICM). However, there is limited information about the trends and outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in ischemic cardiomyopathy patients with multivessel coronary artery disease.
Methods And Results:
Using New Jersey state mandatory registries, 8083 patients with ischemic cardiomyopathy with CABG or PCI revascularization for multivessel coronary artery disease from 2007 to 2018 were included in the analysis. Joinpoint regression and multivariable logistic regression analyses were performed to assess the annual percentage change in trends and predictors of the 30-day mortality rate, respectively. A decline in CABG procedures was observed from 2007 to 2011 (annual percentage change, -11.5%; P=0.003), followed by stabilization. The PCI trend remained unchanged from 2007 to 2010 and then increased significantly (annual percentage change, 3.2%; P=0.02). In the subsample of patients with proximal left anterior descending artery plus circumflex and right coronary artery, CABG was a predominant procedure until 2011, and the proportion of both procedures did not differ thereafter. In the subsample of patients with left anterior descending artery and any other artery stenosis, PCI remained dominant from 2007 to 2018, while in patients with left main and any other artery stenosis, CABG remained dominant from 2007 to 2018 (P<0.001). The 30-day risk-adjusted mortality rate was higher after PCI versus CABG for each year, but after adjustment for completeness of revascularization, there was no difference between groups.
Conclusions:
The patterns of revascularization procedures for patients with ischemic cardiomyopathy with multivessel coronary artery disease have changed over the years, as evidenced by the changes in CABG and PCI trends. CABG and PCI had comparable 30-day risk-adjusted mortality risks.
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