In patients with ischaemic heart failure and multivessel disease, CABG was associated with a lower risk of long-term all-cause mortality compared to PCI (OR 0.62; 95% CI 0.41–0.96; P=0.031).
Observational (n=2,509)
Yes
Does CABG reduce all-cause mortality compared to PCI in patients with heart failure with reduced ejection fraction and multivessel disease?
In patients with ischemic heart failure and multivessel disease, CABG is associated with significantly lower long-term mortality compared to PCI.
Effect estimate: OR 0.62 (95% CI 0.41–0.96)
p-value: p=0.031
Abstract Aims To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of patients with heart failure due to ischaemic heart disease. Methods and results We analysed all-cause mortality following CABG or PCI in patients with heart failure with reduced ejection fraction and multivessel disease (coronary artery stenosis 50% in ≥2 vessels or left main) who underwent coronary angiography between 2000 and 2018 in Sweden. We used a propensity score-adjusted logistic and Cox proportional-hazards regressions and instrumental variable model to adjust for known and unknown confounders. Multilevel modelling was used to adjust for the clustering of observations in a hierarchical database. In total, 2509 patients (82.9% men) were included; 35.8% had diabetes and 34.7% had a previous myocardial infarction. The mean age was 68.1 ± 9.4 years (47.8% were 70 years old), and 64.9% had three-vessel or left main disease. Primary designated therapy was PCI in 56.2% and CABG in 43.8%. Median follow-up time was 3.9 years (range 1 day to 10 years). There were 1010 deaths. Risk of death was lower after CABG than after PCI odds ratio (OR) 0.62; 95% confidence interval (CI) 0.41–0.96; P = 0.031. The risk of death increased linearly with quintiles of hospitals in which PCI was the preferred method for revascularization (OR 1.27, 95% CI 1.17–1.38, P trend 0.001). Conclusion In patients with ischaemic heart failure, long-term survival was greater after CABG than after PCI.
“Our study supports the current European and American guidelines, in which CABG is a preferred method for revascularization of patients with congestive heart failure due to ischemic heart disease.”
Völz et al. (Thu,) conducted a observational in Ischaemic heart failure with reduced ejection fraction and multivessel disease (n=2,509). Coronary artery bypass grafting (CABG) vs. Percutaneous coronary intervention (PCI) was evaluated on All-cause mortality (OR 0.62, 95% CI 0.41–0.96, p=0.031). In patients with ischaemic heart failure and multivessel disease, CABG was associated with a lower risk of long-term all-cause mortality compared to PCI (OR 0.62; 95% CI 0.41–0.96; P=0.031).