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Revascularization and outcomes in ischaemic left ventricular dysfunction after heart failure admission: The

Carlos Moliner-Abós1, Maria Calvo-Barceló2, Eduard Solé-Gonzalez3

  • 1Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain.

European Journal of Heart Failure
|October 3, 2024
PubMed

Insights

Revascularization did not improve long-term survival for heart failure patients with ischaemic left ventricular dysfunction compared to guideline-directed medical therapy. Further prospective studies are needed to confirm these findings.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Heart Failure Management

Background:

  • The role of revascularization in heart failure (HF) with ischaemic left ventricular (LV) dysfunction remains debated.
  • Guideline-directed medical therapy (GDMT) has demonstrated benefits in HF outcomes.

Purpose of the Study:

  • To compare long-term mortality between revascularization and GDMT in patients with ischaemic LV dysfunction post-HF admission.
  • To evaluate the impact of revascularization strategies (PCI vs. CABG) on mortality and LV remodelling.

Main Methods:

  • A multicentre retrospective analysis included 408 patients with HF, LVEF ≤40%, and coronary artery disease (CAD).
  • Patients were treated with either revascularization (PCI or CABG) or GDMT.
  • Primary outcome was all-cause or cardiovascular mortality; secondary outcomes included LV reverse remodelling.

Main Results:

  • After a median follow-up of 44.6 months, revascularization (33% mortality) did not significantly reduce all-cause or cardiovascular mortality compared to GDMT (43% mortality).
  • Neither percutaneous coronary intervention (PCI) nor coronary artery bypass graft (CABG) showed a mortality benefit over GDMT.
  • Both groups showed LV reverse remodelling, with greater improvements observed in the revascularization group.

Conclusions:

  • Revascularization did not demonstrate superior long-term mortality benefits over GDMT in patients with ischaemic LV dysfunction following HF admission.
  • Larger prospective studies are warranted to definitively establish the role of revascularization in this patient population.
Abstract

Keywords:
Guideline‐directed medical therapyIschaemic heart failureIschaemic left ventricular dysfunctionRevascularization

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