Key result
Compared with CABG, PCI in patients with left ventricular systolic dysfunction was associated with higher odds of all-cause mortality (OR 1.15; 95% CI 1.01-1.31; P=0.03).
Why the study?
Data evaluating the optimal revascularization strategy in patients with ischemic left ventricular systolic dysfunction were scarce.
Does percutaneous coronary intervention compared to coronary artery bypass grafting improve clinical outcomes in patients with ischemic left ventricular systolic dysfunction?
Meta-Analysis (n=13,324)
Does percutaneous coronary intervention compared to coronary artery bypass grafting improve clinical outcomes in patients with ischemic left ventricular systolic dysfunction?
Answers are grounded in this paper and cite their sources.
In patients with ischemic left ventricular systolic dysfunction, CABG is associated with lower risks of all-cause mortality, repeat revascularization, and myocardial infarction compared to PCI.
Background: Current guidelines have shown the superiority of coronary artery bypass grafting (CABG) over medical therapy. However, there is a paucity of data evaluating the optimal revascularization strategy in patients with ischemic left ventricular systolic dysfunction (LVSD). Objective: The authors aimed to evaluate the clinical outcomes of postpercutaneous coronary intervention (PCI) and CABG among patients with LVSD. Methods: The authors performed a systematic literature search using the PubMed, Embase, Scopus, and the Cochrane Libraries for relevant articles from inception until 30 November 2022. Outcomes were reported as pooled odds ratio (OR), and their corresponding 95% CI using STATA (version 17.0, StataCorp). Results: A total of 10 studies with 13 324 patients were included in the analysis. The mean age of patients in PCI was 65.3 years, and 64.1 years in the CABG group. The most common comorbidities included: HTN (80 vs. 78%) and DM (49.2 vs. 49%). The mean follow-up duration was 3.75 years. Compared with CABG, the PCI group had higher odds of all-cause mortality (OR 1.15, 95% CI 1.01–1.31, P =0.03), repeat revascularization (OR 3.57, 95% CI 2.56–4.97, P <0.001), MI (OR 1.92, 95% CI 1.01–3.86, P =0.048) while the incidence of cardiovascular mortality (OR 1.23, 95% CI 0.98–1.55, P =0.07), stroke (OR 0.73 95% CI: 0.51–1.04, P =0.08), major adverse cardiovascular and cerebrovascular events (OR 1.36, 95% CI 0.99–1.87, P =0.06), and ventricular tachycardia (OR 0.79, 95% CI 0.22–2.86, P =0.72) was comparable between both the procedures. Conclusion: The results of this meta-analysis suggest that CABG is superior to PCI for patients with LVSD. CABG was associated with a lower risk of all-cause mortality, repeat revascularization, and incidence of myocardial infarction compared with PCI in patients with LVSD.
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Jaiswal et al. (2023) conducted a meta-analysis in Ischemic left ventricular systolic dysfunction (LVSD) (n=13,324). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on All-cause mortality (OR 1.15, 95% CI 1.01-1.31, p=0.03). Compared with CABG, PCI in patients with left ventricular systolic dysfunction was associated with higher odds of all-cause mortality (OR 1.15; 95% CI 1.01-1.31; P=0.03).
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