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Updated: Jun 7, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Outcomes after percutaneous coronary intervention or bypass surgery for ischemic cardiomyopathy
Woochan Kwon1, Onyou Kim2, Ki Hong Choi2
1Department of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
Coronary artery bypass graft (CABG) offers better outcomes than percutaneous coronary intervention (PCI) for ischemic cardiomyopathy. However, complete revascularization with PCI yields results comparable to CABG.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Ischemic cardiomyopathy presents treatment challenges, with revascularization options including percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG).
- The comparative effectiveness of PCI versus CABG for ischemic cardiomyopathy, particularly concerning complete revascularization, remains an area of investigation.
Purpose of the Study:
- To compare the long-term clinical outcomes of PCI versus CABG in patients with ischemic cardiomyopathy and multivessel disease.
- To evaluate the impact of complete revascularization achieved through PCI on outcomes compared to CABG.
Main Methods:
- A single-center cohort registry included 1496 patients with left ventricular ejection fraction <50% and multivessel disease, undergoing either PCI or CABG.
- Patients were stratified into three groups: PCI with complete revascularization (n=188), PCI with incomplete revascularization (n=263), and CABG (n=1045).
- The primary outcome was a composite of cardiac death or myocardial infarction over a 5-year follow-up period.
Main Results:
- Overall, PCI was associated with a higher incidence of the primary outcome compared to CABG (27.8% vs. 22.2%, adjusted HR 1.35).
- However, patients who achieved complete revascularization with PCI demonstrated similar 5-year outcomes to those treated with CABG (20.5% vs. 22.2%, adjusted HR 1.07).
Conclusions:
- Coronary artery bypass graft (CABG) is associated with more favorable clinical outcomes than percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy.
- Achieving complete revascularization during PCI can lead to clinical outcomes comparable to those achieved with CABG.
Introduction And Objectives:
There are 2 options to achieve revascularization in ischemic cardiomyopathy: percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). While the benefits of PCI for ischemic cardiomyopathy are unclear, achieving complete revascularization with PCI could improve outcomes comparable to CABG.
Methods:
A total of 1496 patients with left ventricular ejection fraction (LVEF) <50% and multivessel disease who underwent either PCI or CABG were selected from a single-center cohort registry. They were divided into the PCI with complete revascularization (n=188), the PCI with incomplete revascularization (n=263), and the CABG group (n=1045), and then compared. The primary outcome was a 5-year composite of cardiac death or myocardial infarction.
Results:
A total of 1496 patients treated for ischemic cardiomyopathy was stratified into CABG (n=1045) and PCI (n=451) groups, the latter subdivided into complete (n=188) or incomplete revascularization (n=263). PCI showed a higher incidence of the primary outcome compared with CABG (PCI vs CABG, 27.8% vs 22.2%, adjusted HR, 1.35; 95%CI, 1.05-1.73, P=.019). However, PCI with complete revascularization and CABG had similar incidences of the primary outcome (20.5% vs 22.2%, adjusted HR, 1.07; 95%CI, 0.73-1.57; P=.718).
Conclusions:
CABG is associated with more favorable clinical outcomes than PCI in patients with ischemic cardiomyopathy. However, achieving complete revascularization with PCI could improve outcomes comparable to CABG.
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