Revascularization for Coronary Artery Disease and Mitral Regurgitation: A Systematic Review and Meta-analysis

Background: Coronary artery disease (CAD) and ischemic mitral regurgitation (IMR) commonly co-exist, yet the optimal intervention for these patients is unclear. Herein, we perform a systematic review and meta-analysis comparing the outcomes of patients with multivessel CAD and IMR undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods: PubMed and Embase were systematically searched for articles comparing outcomes of patients with CAD and IMR undergoing revascularization with CABG or PCI, with or without concomitant mitral valve interventions. Thousand two hundred eighty-five studies were identified and 8 were included in this review after full text review. The primary outcome of this study was mortality, and secondary outcomes included myocardial infarction, stroke, heart failure hospitalizations, and residual or recurrent mitral regurgitation. Results: Pooled analyses identified no significant differences in long-term mortality [odds ratio (OR): 1.13, 95% confidence interval (CI): 0.77–1.68, P = 0.53] with considerable heterogeneity between studies. However, following the exclusion of a single outlier, heterogeneity in the pooled analysis of long-term mortality improved and the outcome favored CABG over PCI (OR: 1.39, 95% CI: 1.06–1.83, P = 0.02). Rehospitalization for heart failure also favored CABG (OR: 1.49, 95% CI: 1.16–1.92, P = 0.002). Conclusion: This systematic review and meta-analysis suggested lower rates of long-term mortality and heart failure hospitalizations for CABG compared to PCI. CABG remains preferrable for patients with acceptable surgical risk, multivessel CAD, and IMR.