Revascularization with CABG (HR 0.66; 95% CI 0.61-0.72) or PCI (HR 0.73; 95% CI 0.62-0.85) significantly reduced all-cause mortality compared with medical treatment.
Meta-Analysis (n=16,191)
Does revascularization (CABG or PCI) reduce all-cause mortality compared to medical treatment in patients with coronary artery disease and LVEF ≤40%?
In patients with ischemic heart disease and LVEF ≤40%, revascularization (particularly CABG) significantly improves survival compared to medical therapy alone.
Hazard Ratio: 0.66 (95% CI 0.61–0.72)
p-value: p=<0.001
BACKGROUND: Heart failure with reduced ejection fraction caused by ischemic heart disease is associated with increased morbidity and mortality. It remains unclear whether revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) carries benefits or risks in this group of stable patients compared with medical treatment. METHODS AND RESULTS: We performed a meta-analysis of available studies comparing different methods of revascularization (PCI or CABG) against each other or medical treatment in patients with coronary artery disease and left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality; myocardial infarction, revascularization, and stroke were also analyzed. Twenty-one studies involving a total of 16 191 patients were included. Compared with medical treatment, there was a significant mortality reduction with CABG (hazard ratio, 0.66; 95% confidence interval, 0.61-0.72; P<0.001) and PCI (hazard ratio, 0.73; 95% confidence interval, 0.62-0.85; P<0.001). When compared with PCI, CABG still showed a survival benefit (hazard ratio, 0.82; 95% confidence interval, 0.75-0.90; P<0.001). CONCLUSIONS: The present meta-analysis indicates that revascularization strategies are superior to medical treatment in improving survival in patients with ischemic heart disease and reduced ejection fraction. Between the 2 revascularization strategies, CABG seems more favorable compared with PCI in this particular clinical setting.
Wolff et al. (Sun,) conducted a meta-analysis in Ischemic heart disease with reduced ejection fraction (n=16,191). Coronary artery bypass grafting (CABG) vs. Medical treatment was evaluated on All-cause mortality (HR 0.66, 95% CI 0.61-0.72, p=<0.001). Revascularization with CABG (HR 0.66; 95% CI 0.61-0.72) or PCI (HR 0.73; 95% CI 0.62-0.85) significantly reduced all-cause mortality compared with medical treatment.