Georg Wolff1, Dimitrios Dimitroulis1, Felicita Andreotti1, Michalina Kołodziejczak1, Christian Jung1, Pietro Scicchitano1, Fiorella Devito1, Annapaola Zito1, Michele Occhipinti1, Battistina Castiglioni1, Giuseppe Calveri1, Francesco Maisano1, Marco M Ciccone1, Stefano De Servi1, Eliano P Navarese2. 1. From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.). 2. From the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.). elianonavarese@gmail.com.
Abstract
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.
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.
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