Alexander Iribarne1, Anthony W DiScipio2, Bruce J Leavitt3, Yvon R Baribeau4, Jock N McCullough2, Paul W Weldner5, Yi-Ling Huang2, Michael P Robich6, Robert A Clough7, Gerald L Sardella8, Elaine M Olmstead2, David J Malenka2. 1. Section of Cardiac Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: alexander.iribarne@hitchcock.org. 2. Section of Cardiac Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 3. Department of Cardiothoracic Surgery, Heart and Vascular, University of Vermont Medical Center, Burlington, Vt. 4. New England Heart and Vascular Institute, Catholic Medical School, Manchester, NH. 5. Central Maine Medical Center, Lewiston, Me. 6. MMC Cardiovascular Institute, Maine Medical Center, Portland, Maine. 7. Heart Care, Eastern Maine Medical Center, Bangor, Maine. 8. Center for Cardiac Care, Concord Hospital, Concord, NH.
Abstract
OBJECTIVE: There are no prospective randomized trial data to guide decisions on optimal revascularization strategies for patients with multivessel coronary artery disease and reduced ejection fraction. In this analysis, we describe the comparative effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in this patient population. METHODS: A multicenter, retrospective analysis of all CABG (n = 18,292) and PCIs (n = 55,438) performed from 2004 to 2014 among 7 medical centers reporting to the Northern New England Cardiovascular Disease Study Group. After applying inclusion and exclusion criteria from the Surgical Treatment for Ischemic Heart Failure trial, there were 955 CABG and 718 PCI patients with an ejection fraction ≤ 35% and 2- or 3-vessel disease. Inverse probability weighting was used for risk adjustment. The primary end point was all-cause mortality. Secondary end points included rates of 30-day mortality, stroke, acute kidney injury, and incidence of repeat revascularization. RESULTS: The median duration of follow-up was 4.3 years (range, 1.59-6.71 years). CABG was associated with improved long-term survival compared with PCI after risk adjustment (hazard ratio, 0.59; 95% confidence interval, 0.50-0.71; P < .01). Although CABG and PCI had similar 30-day mortality rates (P = .14), CABG was associated with a higher frequency of stroke (P < .001) and acute kidney injury (P < .001), whereas PCI was associated with a higher incidence of repeat revascularization (P < .001). CONCLUSIONS: Among patients with reduced ejection fraction and multivessel disease, CABG was associated with improved long-term survival compared with PCI. CABG should be strongly considered in patients with ischemic cardiomyopathy and multivessel coronary disease.
OBJECTIVE: There are no prospective randomized trial data to guide decisions on optimal revascularization strategies for patients with multivessel coronary artery disease and reduced ejection fraction. In this analysis, we describe the comparative effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in this patient population. METHODS: A multicenter, retrospective analysis of all CABG (n = 18,292) and PCIs (n = 55,438) performed from 2004 to 2014 among 7 medical centers reporting to the Northern New England Cardiovascular Disease Study Group. After applying inclusion and exclusion criteria from the Surgical Treatment for Ischemic Heart Failure trial, there were 955 CABG and 718 PCI patients with an ejection fraction ≤ 35% and 2- or 3-vessel disease. Inverse probability weighting was used for risk adjustment. The primary end point was all-cause mortality. Secondary end points included rates of 30-day mortality, stroke, acute kidney injury, and incidence of repeat revascularization. RESULTS: The median duration of follow-up was 4.3 years (range, 1.59-6.71 years). CABG was associated with improved long-term survival compared with PCI after risk adjustment (hazard ratio, 0.59; 95% confidence interval, 0.50-0.71; P < .01). Although CABG and PCI had similar 30-day mortality rates (P = .14), CABG was associated with a higher frequency of stroke (P < .001) and acute kidney injury (P < .001), whereas PCI was associated with a higher incidence of repeat revascularization (P < .001). CONCLUSIONS: Among patients with reduced ejection fraction and multivessel disease, CABG was associated with improved long-term survival compared with PCI. CABG should be strongly considered in patients with ischemic cardiomyopathy and multivessel coronary disease.
Authors: Abduzhappar Gaipov; Miklos Z Molnar; Praveen K Potukuchi; Keiichi Sumida; Robert B Canada; Oguz Akbilgic; Kairat Kabulbayev; Zoltan Szabo; Santhosh K G Koshy; Kamyar Kalantar-Zadeh; Csaba P Kovesdy Journal: J Thorac Cardiovasc Surg Date: 2018-09-27 Impact factor: 5.209
Authors: Brett W Sperry; Timothy M Bateman; Esma A Akin; Paco E Bravo; Wengen Chen; Vasken Dilsizian; Fabien Hyafil; Yiu Ming Khor; Robert J H Miller; Riemer H J A Slart; Piotr Slomka; Hein Verberne; Edward J Miller; Chi Liu Journal: J Nucl Cardiol Date: 2022-07-21 Impact factor: 3.872
Authors: Sérgio Costa Rayol; Michel Pompeu Barros Oliveira Sá; Luiz Rafael Pereira Cavalcanti; Felipe Augusto Santos Saragiotto; Roberto Gouvea Silva Diniz; Frederico Browne Correia de Araújo E Sá; Alexandre Motta de Menezes; Ricardo Carvalho Lima Journal: Braz J Cardiovasc Surg Date: 2019 Jan-Feb