Coronary Artery Bypass Graft Surgery Brings Better Benefits to Heart Failure Hospitalization for Patients with Severe Coronary Artery Disease and Reduced Ejection Fraction

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  Figure 1. Flow chart of study population. Between 2006 February and 2020 February, a total of 797 patients received coronary angiograms due to left ventricular ejection fraction ≤40% in our hospital. We excluded patients of dilated cardiomyopathy or severe valvular heart disease with and without surgery (n = 256), prior history of coronary artery bypass grafting (CABG) (n = 69), acute ST-segment myocardial infarction (n = 103), coronary artery disease with low SYNTAX score ≤22 (n = 185) and emergent CABG for coronary perforation (n = 3). Percutaneous coronary intervention group was classified into complete revascularization (CR) group (PCI-CR) (n = 74) and incomplete-CR group (PCI-ICR) (n = 49). Abbreviation: CAG: coronary angiography; LVEF: left ventricular ejection fraction; CABG: coronary artery bypass grafting; PCI: percutaneous coronary intervention; CR: complete revascularization; ICR: incomplete revascularization.

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  Figure 2. Kaplan–Meier curves of all-cause mortality and heart failure hospitalization between groups. (A) CABG vs. PCI: A higher incidence of all-cause mortality was noted at the one-year follow-up period (log-rank p = 0.008) and did not differ at the three-year follow-up period (log-rank p = 0.088); (B) CABG vs. PCI-CR vs. PCI-ICR: CABG group had a higher incidence of all-cause mortality at the one-year follow-up period (log-rank p = 0.030), and no significant difference was noted at the three-year follow-up period (log-rank p = 0.232). Abbreviation: CABG: coronary artery bypass grafting; PCI: percutaneous coronary intervention; CR: complete revascularization; ICR: incomplete revascularization; (C) CABG vs. PCI: CABG group had a lower incidence of HF hospitalization at one-year follow-up period (log-rank p = 0.019) and three-year follow-up period (log-rank p < 0.001); (D) CABG vs. PCI-CR vs. PCI-ICR: there was no significant difference at the one-year follow-up period (log-rank p = 0.062) and CABG group had a significantly lower incidence of HF hospitalization at three-year follow-up period (log-rank p = 0.002).

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  Figure 3. Kaplan–Meier curves of all-cause mortality and heart failure hospitalization at follow-up period between CABG and PCI groups by a different range of SYNTAX score. (A) CABG vs. PCI (SYNTAX score ≥ 33): A better survival outcome was noted at the one-year follow-up period (log-rank p = 0.012) and did not differ at the three-year follow-up period between CABG and PCI groups (log-rank p = 0.459); (B) CABG vs. PCI (SYNTAX score between 22 and 33): There was no significant difference at the one-year and three-year follow-up period between CABG and PCI groups.; (C) CABG vs. PCI (SYNTAX score ≥ 33): CABG group had a significantly lower incidence of HF hospitalization at the one-year (log-rank p = 0.002) and three-year (log-rank p < 0.001) follow-up period; (D) CABG vs. PCI (SYNTAX score between 22 and 33): There was no significant difference at the one-year and three-year follow-up period between CABG and PCI groups.