Synergy of Coronary Revascularization and Optimal Drug Therapy in Patients With Ischemic Cardiomyopathy and Reduced...

To evaluate the clinical, functional and prognostic outcomes, including left ventricular (LV) reverse remodeling, of combining percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) in patients with ischemic cardiomyopathy (ICM) and reduced left ventricular ejection fraction (LVEF).

ICM with significantly reduced LVEF remains one of the severe forms of chronic heart failure (CHF), associated with a high risk of adverse outcomes. The choice of the optimal treatment strategy, coronary revascularization in addition to intensive medical therapy, is a subject of active discussion and requires further study, especially regarding its effect on LV reverse remodeling and long-term prognosis. This retrospective cohort study included 561 patients with ICM and LVEF <40%. The follow-up lasted from 2014 through 2024. 74% of the patients were men aged 61.4±8.7 years. Patients were divided into a revascularization group (PCI+OMT, n=281) and an OMT group (n=280). The structural and functional state of the heart was assessed using transthoracic echocardiography (ECHO) with standard protocols.

The OMT group had a significantly higher EuroSCORE II surgical risk (4.0±1.9% vs. 3.0±1.5% in the PCI+OMT group; p<0.05), a greater prevalence of stage III or higher chronic kidney disease (35.7% vs. 17.8%; p<0.05), and more severe LV dilatation (LV end-diastolic volume 265±54 ml vs. 245±45 ml; p<0.05). The PCI+OMT group presented with significantly higher anatomical lesion complexity compared to the OMT group (SYNTAX Score 33.5±8.8 vs. 28.9±9.7, p<0.05). At the 24-month follow-up, the PCI+OMT group demonstrated a superior improvement in LVEF (+10.7±6.8% vs. +2.1±4.5%, p<0.001). The proportion of patients with severe mitral regurgitation (III+) was lower in the PCI+OMT group (5.3% vs. 16.1%, p<0.001), and overall mortality was 10.7% vs. 23.2% in the OMT group (p<0.001). The CHF-related hospitalization rate was also significantly lower in the PCI+OMT group than in the OMT group (17.8% vs. 33.9%; p<0.001).

The combination of PCI and OMT is associated with a pronounced recovery of myocardial contractility, reverse LV remodeling, and regression of functional mitral regurgitation. The structural changes in the myocardium achieved through the integrative approach translate into a significant reduction in overall mortality and hospitalizations rates due to decompensated CHF during mid-term follow-up.