Percutaneous coronary intervention was associated with higher adjusted mortality than coronary artery bypass grafting at 3 years in patients with heart failure (HR 1.79; 95% CI 1.13-2.82; P=0.01).
Cohort (n=1,064)
Does percutaneous coronary intervention compared to coronary artery bypass grafting improve outcomes in patients with multivessel and/or left main disease and a history of heart failure?
In patients with heart failure and advanced coronary artery disease, CABG is associated with better 3-year survival than PCI, particularly in those with high SYNTAX scores.
Effect estimate: HR 1.79 (95% CI 1.13-2.82)
p-value: p=0.01
OBJECTIVES: Ischaemic heart disease is a major risk factor for heart failure. However, long-term benefit of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in those patients has not been well elucidated. METHODS: Of the 15 939 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2, we identified 1064 patients with multivessel and/or left main disease with a history of heart failure (ACC/AHA Stage C or D). RESULTS: There were 672 patients undergoing PCI and 392 CABG. Preprocedural left ventricular ejection fraction was not different between PCI and CABG (46.6 ± 15.1 vs 46.6 ± 14.6%, P = 0.89), but the CABG group included more patients with triple-vessel and left main disease (P < 0.01 each). Three-year outcomes revealed that the risk of hospital readmission for heart failure was higher after PCI than after CABG (hazard ratio 95% confidence interval; 1.90 1.18-3.05, P = 0.01). More importantly, adjusted mortality after PCI was significantly higher than after CABG (1.79 1.13-2.82, P = 0.01). The risk of cardiac death after PCI was also higher than after CABG (1.98 1.10-3.55, P = 0.02). Stratified analysis using the SYNTAX score demonstrated that risk of death was not different between PCI and CABG in patients with low (<23) and intermediate (23-32) SYNTAX scores (2.10 0.57-7.68, P = 0.26 and 1.43 0.63-3.21, P = 0.39, respectively), whereas those with a high (≥ 33) SYNTAX score, the risk of death was far higher after PCI than after CABG (4.83 1.46-16.0, P = 0.01). CONCLUSIONS: In patients with heart failure with advanced coronary artery disease, CABG was a better option than PCI because CABG was associated with better survival benefit, particularly in more complex coronary lesions stratified by the SYNTAX score.
Marui et al. (Sun,) conducted a cohort in Heart failure with multivessel and/or left main coronary artery disease (n=1,064). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on Adjusted mortality (HR 1.79, 95% CI 1.13-2.82, p=0.01). Percutaneous coronary intervention was associated with higher adjusted mortality than coronary artery bypass grafting at 3 years in patients with heart failure (HR 1.79; 95% CI 1.13-2.82; P=0.01).