Why the study?
Limited information exists regarding optimal revascularization strategies for patients with triple-vessel coronary artery disease, heart failure, and different degrees of mitral regurgitation.
Does percutaneous coronary intervention compared to coronary artery bypass grafting improve the composite of cardiovascular death and heart failure hospitalization in patients with triple-vessel coronary artery disease, left ventricular dysfunction, and non-severe mitral regurgitation?
Observational (n=1,190)
No
Does percutaneous coronary intervention compared to coronary artery bypass grafting improve the composite of cardiovascular death and heart failure hospitalization in patients with triple-vessel coronary artery disease, left ventricular dysfunction, and non-severe mitral regurgitation?
In patients with heart failure and triple-vessel disease, CABG is associated with lower rates of cardiovascular death and heart failure hospitalization compared to PCI, especially in those with moderate mitral regurgitation.
Answers are grounded in this paper and cite their sources.
PCI associated with higher CV death/HF hospitalization risk than CABG in moderate MR; leaves open optimal revascularization strategy.
Aims: Limited information exists regarding optimal revascularization options for patients with triple-vessel coronary artery disease (TVD), heart failure (HF), and different degrees of mitral regurgitation (MR). Thus, we aimed to compare the effect of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) surgery in the indicated patients. Methods and Results: In the real-world prospective study, 1190 patients with multi-vessel disease and decreased left ventricular systolic function but without severe MR, who underwent PCI or CABG, were enrolled and followed-up for 4.7 ± 1.8 years. The primary endpoint was a composite of cardiovascular death and HF hospitalization. Secondary endpoints were the individual components of the primary outcome. Risk of the primary endpoint was higher in the PCI than in the CABG group (HR = 1.38, 95%CI: 1.14–1.67, and P < 0.01), particularly in patients with moderate MR (HR = 1.85, 95%CI: 1.35–2.55, and P < 0.01). In patients with no-mild MR, the risk of the primary endpoint did not differ significantly between PCI and CABG ( P = 0.09). Treatment with PCI was associated with an increased risk for cardiovascular death and HF hospitalization in the moderate MR cohort, while PCI was comparable to CABG in the no-mild MR cohort. Conclusions: In this real-world study, for patients with HF and TVD, CABG was related to lower adverse outcome rates compared to PCI. Assessment of MR can aid in selecting optimal revascularization therapies and in risk stratification.
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Fan et al. (2021) conducted an observational in Left Ventricular Dysfunction and Three-Vessel Coronary Disease (n=1,190). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on Composite of cardiovascular death and first re-admission due to heart failure (HR 1.38, 95% CI 1.14-1.67, p=<0.01).
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