Therapeutics and Clinical Risk Management (Oct 2021)
Clinical Outcomes of Patients with Coronary Artery Diseases and Moderate Left Ventricular Dysfunction: Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Surgery
Abstract
Shaoping Wang,1,2 Yi Lyu,3 Shujuan Cheng,1 Jinghua Liu,1 Bijan J Borah2,4 1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA; 3Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China; 4Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USACorrespondence: Bijan J BorahDepartment of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USAEmail [email protected] LiuDepartment of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, People’s Republic of ChinaTel/Fax +86 10 64456998Email [email protected]: Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are two revascularization strategies for patients with coronary artery disease (CAD) and left ventricular dysfunction. However, the comparisons of effectiveness between the two strategies are insufficient. This study is aimed to compare the effectiveness between PCI and CABG among patients with moderate left ventricular dysfunction.Patients and Methods: A total of 1487 CAD patients with moderate reduced ejection fraction (36%≤EF≤ 40%), who underwent either PCI or CABG, were enrolled in a real-world cohort study (No. ChiCTR2100044378). Clinical outcomes included short- and long-term all-cause mortality, rates of heart failure (HF) hospitalization and repeat revascularization. Propensity score matching was used to balance the two cohorts.Results: PCI was associated with lower 30-day mortality rate (hazard ratio [HR] [95% CI], 0.35 [0.15– 0.83]; P=0.02). At a mean follow-up of 4.5 years, PCI and CABG had similar all-cause death (HR [95% CI], 0.82 [0.56– 1.20]; P=0.30) and heart failure (HF) hospitalization (HR [95% CI], 0.93 [0.54– 1.60]; P=0.79), but PCI had higher risk of repeat revascularization (HR [95% CI], 8.62 [3.67– 20.23]; P< 0.001). Improvement in EF measured at 3 months later after revascularization was also similar between PCI and CABG (P for interaction=0.87).Conclusion: CAD patients with moderate reduced EF who had PCI had lower short-term mortality rate but higher risk of repeat revascularization during follow-up than patients who had CABG. PCI showed comparable long-term survival, HF hospitalization risk, and EF improvement.Keywords: bypass, ejection fraction, heart failure, revascularization, stents
