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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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Surgical Risk and Long-Term Mortality With PCI and CABG in Ischemic Left Ventricular Systolic Dysfunction.

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Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) revascularization effects for ischemic left ventricular systolic dysfunction (iLVSD) are not influenced by baseline surgical risk. Both CABG and PCI showed consistent outcomes regardless of patient risk stratification.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Ischemic left ventricular systolic dysfunction (iLVSD) patients benefit from coronary artery bypass grafting (CABG) over optimal medical therapy (OMT), but percutaneous coronary intervention (PCI) offers no clear advantage.
  • Randomized controlled trials (RCTs) comparing revascularization strategies may have varying baseline surgical risk profiles.
  • Investigating the influence of baseline surgical risk on treatment effects is crucial for understanding revascularization outcomes in iLVSD.

Purpose of the Study:

  • To determine if baseline surgical risk modifies the treatment effect of PCI versus OMT in patients with iLVSD.
  • To assess whether baseline surgical risk impacts the effectiveness of CABG compared to OMT in iLVSD patients.
  • To analyze the interaction between revascularization strategy (PCI or CABG) and surgical risk on all-cause mortality.

Main Methods:

  • Post hoc analysis of the REVIVED-BCIS2 (PCI vs. OMT) and STICH (CABG vs. OMT) RCTs involving patients with iLVSD.
  • All-cause mortality was the primary outcome measure.
  • Baseline surgical risk was estimated using a modified European System for Cardiac Operative Risk Evaluation (EuroSCORE)-II, and its interaction with treatment was quantified.

Main Results:

  • The REVIVED-BCIS2 trial (n=666) showed PCI had no significant effect on mortality versus OMT across all baseline surgical risk tertiles (P interaction = .79).
  • The STICH trial (n=1200) demonstrated that CABG consistently reduced mortality compared to OMT across all baseline surgical risk tertiles (P interaction = .64).
  • Participants in the REVIVED-BCIS2 trial had a higher proportion in the highest baseline EuroSCORE-II tertile compared to the STICH trial (40.4% vs. 29.4%).

Conclusions:

  • The treatment effect of PCI versus OMT for iLVSD is not modified by baseline surgical risk.
  • The mortality benefit of CABG versus OMT in iLVSD patients is consistent across varying levels of baseline surgical risk.
  • These findings, from two large RCTs, suggest baseline surgical risk does not alter the comparative effectiveness of PCI or CABG against OMT in iLVSD.