Revascularisation in Left Ventricular Systolic Dysfunction: A Meta-analysis of Kaplan-Meier Reconstructed Individual...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Coronary artery disease frequently causes ischemic left ventricular systolic dysfunction (LVSD).
• The optimal revascularization strategy for LVSD remains debated.
• This study compares percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in LVSD patients.

Purpose of the Study:

• To determine the survival advantage of PCI versus CABG in patients with LVSD.
• To compare mortality, myocardial infarction, stroke, and revascularization rates between PCI and CABG.

Main Methods:

• Study-level (SLMA) and reconstructed individual patient data (rIPDMA) meta-analyses were conducted.
• Systematic search of Medline, Embase, and Cochrane Library for studies published after 2010.
• Included studies compared PCI and CABG in patients with left ventricular ejection fraction ≤ 40%.

Main Results:

• PCI was associated with increased all-cause mortality, myocardial infarction, and repeat revascularization compared to CABG in SLMA.
• rIPDMA confirmed higher all-cause mortality and repeat revascularization with PCI.
• PCI showed a lower risk of stroke in the rIPDMA, attributed to fewer early events.

Conclusions:

• Percutaneous coronary intervention (PCI) is linked to higher mortality and revascularization rates than coronary artery bypass grafting (CABG) in ischemic LVSD.
• CABG may offer a survival advantage in this patient group.
• PCI demonstrated a reduced risk of short-term stroke.