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PCI in Patients With Heart Failure: Current Evidence, Impact of Complete Revascularization, and Contemporary
Yousif Ahmad1, Mark C Petrie2, E Marc Jolicoeur3
1Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut.
Insights
Coronary artery bypass grafting improves survival in heart failure patients, but percutaneous coronary intervention offers a less invasive alternative. Further trials are needed to clarify PCI
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) is a leading cause of left ventricular systolic dysfunction (LVSD) and heart failure (HF).
- Coronary artery bypass grafting (CABG) improves survival but is underutilized in HF patients due to surgical risks and patient factors.
- Percutaneous coronary intervention (PCI) presents a less invasive revascularization option for HF patients.
Purpose of the Study:
- To review current evidence on PCI for revascularization in heart failure patients.
- To examine the relationship between revascularization extent and clinical outcomes in HF.
- To discuss advancements in PCI technology and techniques relevant to HF treatment.
Main Methods:
- Review of existing literature on PCI in heart failure.
- Analysis of the association between revascularization extent and outcomes.
- Discussion of recent technological and technical advances in PCI.
- Examination of emerging clinical trial data and evidence gaps.
Main Results:
- CABG reduces mortality in HF patients compared to medical therapy.
- PCI is a less invasive alternative to CABG with potential for reduced complications.
- Advances in PCI allow for more complete revascularization in high-risk HF patients.
- No randomized controlled trials directly compare PCI with medical therapy or CABG in HF.
Conclusions:
- PCI is a promising revascularization strategy for heart failure patients, particularly those at high surgical risk.
- Further clinical trials are essential to establish the efficacy and safety of PCI compared to existing treatments.
- Addressing evidence gaps through rigorous research is crucial for optimizing revascularization strategies in HF.
Abstract:
Coronary artery disease (CAD) is the most common cause of left ventricular systolic dysfunction (LVSD) and heart failure (HF). Revascularization with coronary artery bypass grafting (CABG) reduces all-cause mortality compared with medical therapy alone for these patients. Despite this, CABG is performed in a minority of patients with HF, partly due to patient unwillingness or inability to undergo major cardiac surgery and partly due to physician reluctance to refer for surgery due to high operative risk. Percutaneous coronary intervention (PCI) is a less-invasive method of revascularization that has the potential to reduce periprocedural complications compared with CABG in patients with HF. Recent advances in PCI technology and technique have made it realistic to achieve more complete revascularization with PCI in high-risk patients with HF, although no randomized controlled clinical trials (RCTs) of PCI in HF compared with either medical therapy or CABG have been performed. In this review, we discuss the currently available evidence for PCI in HF and the association between the extent of revascularization and clinical outcomes in HF. We also review recent advances in PCI technology and techniques with the potential to improve clinical outcomes in HF. Finally, we discuss emerging clinical trial evidence of revascularization in HF and the large, persistent evidence gaps that should be addressed with future clinical trials of revascularization in HF.
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