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Utility of coronary revascularization in patients with ischemic left ventricular dysfunction
Mohammed Al-Sadawi1, Michael Tao2, Simrat Dhaliwal2
1Division of Cardiology, University of Michigan Hospital, Ann Arbor, MI, USA.
Insights
Coronary revascularization significantly lowers mortality in patients with ischemic left ventricular dysfunction, regardless of procedure type or dysfunction severity. However, it does not reduce heart failure hospitalizations or heart attacks, and offers no mortality benefit in patients without viable myocardium.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Management
Background:
- Uncertainty surrounds revascularization outcomes in patients with left ventricular (LV) dysfunction.
- Factors like myocardial viability, LV dysfunction severity, and revascularization method (PCI vs. CABG) complicate treatment decisions.
Purpose of the Study:
- To evaluate the association between coronary revascularization and patient outcomes.
- Specifically focusing on individuals with ischemic LV dysfunction.
Main Methods:
- A comprehensive literature search was performed.
- Included studies compared cardiovascular outcomes after revascularization versus optimal medical therapy (OMT).
- Analyzed data from 23 studies involving 10,110 participants.
Main Results:
- Revascularization significantly reduced all-cause and cardiovascular mortality compared to OMT.
- This mortality benefit was observed irrespective of LV dysfunction severity or revascularization method.
- No significant difference in heart failure hospitalization or acute myocardial infarction risk was found between groups.
- Mortality benefit was noted in patients with viable myocardium but not in those without viable myocardium.
Conclusions:
- Coronary revascularization improves survival in ischemic LV dysfunction, independent of LV dysfunction severity or revascularization technique.
- Patients without viable myocardium do not benefit from revascularization regarding mortality.
- Revascularization does not decrease the risk of acute myocardial infarction or heart failure hospitalizations.
Background:
Revascularization in patients with left ventricular (LV) dysfunction has been a subject of ongoing uncertainty and conflicting results. This is further complicated by factors including viability, severity of LV dysfunction, and method of revascularization using percutaneous coronary intervention (PCI) versus coronary-artery bypass grafting (CABG).
Objectives:
The purpose of this meta-analysis is to evaluate the association of coronary revascularization with outcomes in patients with ischemic LV dysfunction.
Methods:
A literature search was conducted for studies reporting on cardiovascular outcomes after revascularization compared to optimal medical therapy (OMT) in patients with ischemic LV dysfunction.
Results:
A total of 23 studies with 10,110 participants met inclusion criteria. Revascularization was significantly associated with lower all-cause mortality and CV mortality compared to OMT. The association was statistically significant regardless of severity of LV dysfunction or method of revascularization. Subgroup analysis demonstrated that revascularization was significantly associated with lower all-cause and CV mortality compared to OMT for patients with viable myocardium and mixed cohorts with variable viability, but not patients without viable myocardium. Revascularization was not associated with a significant difference in risk of heart failure (HF) hospitalization or acute myocardial infarction (AMI) compared to OMT.
Conclusions:
Revascularization in patients with ischemic LV dysfunction is associated with lower risk of all-cause and CV mortality independent of severity of LV dysfunction or method of revascularization. Revascularization is not associated with lower risk of mortality in patients without evidence of viable myocardium and is not associated with lower risk of AMI or HF hospitalization.
