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Updated: Jan 15, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Coronary artery bypass grafting versus percutaneous coronary intervention in heart failure with reduced left
Lorenzo Di Bacco1, Michele D'Alonzo2, Fabrizio Rosati1
1Division of Cardiac Surgery, University of Brescia, ASST-Spedali Civili di Brescia, Brescia, Italy.
Insights
Coronary artery bypass grafting (CABG) shows better long-term survival than percutaneous coronary intervention (PCI) for heart failure patients with reduced ejection fraction. CABG significantly lowers cardiac death and repeat revascularization rates over 10 years.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Heart failure with left ventricular systolic dysfunction (LVEF <50%) and multivessel coronary artery disease presents complex treatment challenges.
- Myocardial revascularization strategies include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
- Long-term comparative outcomes between CABG and PCI in this patient population require further investigation.
Purpose of the Study:
- To compare the 10-year clinical outcomes of patients with heart failure and left ventricular systolic dysfunction undergoing myocardial revascularization via CABG versus PCI.
- To evaluate differences in all-cause mortality, cardiac death, stroke, and repeat revascularization between the two treatment groups.
Main Methods:
- Retrospective, single-center study of 707 patients with multivessel coronary artery disease and LVEF <50%.
- Patients were treated with either CABG (429) or PCI (278) between January 2002 and December 2023.
- Propensity-score matching (1:1) was used to adjust for baseline covariates, resulting in 196 matched pairs for analysis.
Main Results:
- Thirty-day mortality rates were similar between CABG and PCI groups (3.1% vs. 2.6%, p=0.99).
- At 10-year follow-up, CABG demonstrated significantly higher overall survival (55% vs. 37%, p<0.001) and lower rates of cardiac death (12.3% vs. 23.4%, p=0.049) and repeat target revascularization (7.4% vs. 23.4%, p=0.003).
- Stroke incidence was comparable between the groups (5.3% vs. 10.2%, p=0.440).
Conclusions:
- While early outcomes are similar, CABG offers superior long-term survival benefits compared to PCI in patients with heart failure and left ventricular systolic dysfunction.
- CABG is associated with reduced cardiac death and a lower need for repeat revascularization over a 10-year period.
- Surgical revascularization (CABG) should be strongly considered for patients with multivessel coronary artery disease and systolic heart failure to improve long-term survival.
Background:
The present study aims to compare the 10-year outcomes of patients with heart failure and left ventricular systolic dysfunction undergoing myocardial revascularization through coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).
Methods:
This retrospective, single-center study enrolled 707 patients (pts) treated with CABG (429 pts) or PCI (278 pts) for multivessel coronary artery disease and left ventricular systolic dysfunction (LVEF <50 %). Data were collected between January 2002 and December 2023. Preoperative covariates were adjusted using 1:1 propensity-score matching. The primary endpoints were 30-day and long-term all-cause mortality. Secondary endpoints included the incidence of stroke and repeat target revascularization.
Results:
After propensity-score matching, 196 comparable pairs were identified. The 30-day mortality rates were similar between the groups (CABG: 6 pts., 3.1 % vs. PCI: 5 pts., 2.6 %; p = 0.99). At the 10-year follow-up, CABG group showed higher overall survival (CABG: 55 % vs. PCI: 37 %, p < 0.001), a lower incidence of cardiac death (CABG: 12.3 % vs. PCI: 23.4 %, p = 0.049) and repeat target revascularization (CABG: 7.4 % vs. PCI: 23.4 %, p = 0.003). The incidence of stroke was comparable between the two groups (CABG: 5.3 % vs. PCI: 10.2 %, p = 0.440).
Conclusions:
Early outcomes were comparable between PCI and CABG. However, at 10 years, CABG was associated with superior overall survival, lower cardiac death and reduced repeat revascularization rates. Therefore, surgical revascularization should be strongly considered in patients with multivessel coronary artery disease and heart failure with left ventricular systolic dysfunction to achieve long-term survival benefits.
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