Complete revascularization was associated with a significantly reduced risk of heart failure hospitalization or cardiovascular death in patients with acute coronary syndrome and an LVEF of 40%-50% (HR 0.46), though the adjusted benefit was not significant in the overall cohort with LVEF ≥ 40%.
Cohort (n=1,834)
Does complete revascularization reduce the composite outcome of first hospitalization for heart failure or cardiovascular death in patients with acute coronary syndrome, multivessel disease, and LVEF ≥ 40%?
Complete revascularization reduces the risk of heart failure hospitalization or cardiovascular death in ACS patients with multivessel disease and mildly reduced ejection fraction (40-50%), particularly in those with NSTE-ACS.
Effect estimate: HR 0.56 (95% CI 0.38-0.83)
Absolute Event Rate: 4.6% vs 7.8%
p-value: p=<0.001
Objective To investigate the impact of complete revascularization (CR) versus incomplete revascularization (ICR) on the composite outcome of first hospitalization for heart failure (HF) or cardiovascular death in patients with acute coronary syndrome (ACS) and a left ventricular ejection fraction (LVEF) ≥ 40%. Methods This retrospective study enrolled 1,834 patients with ACS, multivessel disease, and an LVEF ≥ 40% (767 CR and 1,067 ICR). CR was defined as percutaneous coronary intervention (PCI) of all suitable non-culprit lesions during index hospitalization or within 45 days postdischarge. The primary endpoint was the first occurrence of hospitalization for HF or cardiovascular death. At discharge, almost all patients received dual antiplatelet therapy and guideline-directed medical therapy. Result During the follow-up period, 35 of the 767 patients (4.6%) in the CR group and 83 of the 1,067 (7.8%) patients in the ICR group reached the primary endpoint ( p 0.001). After adjusting for covariates, CR was associated with a lower risk of the primary endpoint in the population with an LVEF 50% hazard ratio (HR), 0.46; 95% confidence interval (CI), 0.22–0.96. This benefit was confined to patients with non-ST-segment elevation ACS (NSTE–ACS) (HR 0.41; 95% CI 0.20–0.83) but was not observed in the ST-segment elevation myocardial infarction (STEMI) subgroup. Conclusion CR is associated with a significantly reduced risk of HF hospitalization or cardiovascular death in patients with an LVEF of 40%–50%. This benefit attenuated as the LVEF increased, highlighting a potential LVEF-dependent efficacy. Although these results are promising, the observational nature of this study and the potential for residual confounding necessitate cautious interpretation.
Luo et al. (Mon,) conducted a cohort in Acute coronary syndrome with multivessel disease and LVEF ≥ 40% (n=1,834). Complete revascularization vs. Incomplete revascularization (culprit-only) was evaluated on First occurrence of hospitalization for heart failure or cardiovascular death (HR 0.56, 95% CI 0.38-0.83, p=<0.001). Complete revascularization was associated with a significantly reduced risk of heart failure hospitalization or cardiovascular death in patients with acute coronary syndrome and an LVEF of 40%-50% (HR 0.46), though the adjusted benefit was not significant in the overall cohort with LVEF ≥ 40%.