Percutaneous coronary intervention versus coronary artery bypass grafting in patients with reduced ejection fraction.

Tytuł:: Percutaneous coronary intervention versus coronary artery bypass grafting in patients with reduced ejection fraction.
Autorzy:: Bianco V; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
Kilic A; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Mulukutla S; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Gleason TG; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Kliner D; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Allen CC; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Habertheuer A; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
Aranda-Michel E; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
Humar R; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
Navid F; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Wang Y; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Sultan I; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: .
Źródło:: The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2021 Mar; Vol. 161 (3), pp. 1022-1031.e5. Date of Electronic Publication: 2020 Sep 16.
Typ publikacji:: Comparative Study; Journal Article; Webcast
Język:: English
Imprint Name(s):: Publication: St. Louis, MO : Mosby
Original Publication: St. Louis.
MeSH Terms:: Coronary Artery Bypass*/adverse effects
Coronary Artery Bypass*/mortality
Percutaneous Coronary Intervention*/adverse effects
Percutaneous Coronary Intervention*/mortality
Ventricular Function, Left*
Coronary Artery Disease/*therapy
Aged ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/mortality ; Coronary Artery Disease/physiopathology ; Databases, Factual ; Female ; Humans ; Male ; Middle Aged ; Patient Readmission ; Pennsylvania ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke Volume ; Time Factors ; Treatment Outcome
Contributed Indexing:: Keywords: CABG; PCI; low EF; percutaneous
Entry Date(s):: Date Created: 20201016 Date Completed: 20210322 Latest Revision: 20210322
Update Code:: 20240105
DOI:: 10.1016/j.jtcvs.2020.06.159
PMID:: 33059935
: Czasopismo naukowe

Objective: The aim of this study was to evaluate comparative outcomes for percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with reduced ejection fraction.
Methods: All patients from the University of Pittsburgh Medical Center from 2011 to 2018 who had reduced preoperative ejection fraction (<50%) and underwent CABG or PCI for coronary revascularization were included in this study. Patients were risk-adjusted with propensity matching (1:1) and primary outcomes included long-term survival, readmission, and major adverse cardiac and cerebrovascular events (MACCE).
Results: A total of 2000 patients were included in the current study, consisting of CABG (n = 1553) and PCI (n = 447) cohorts with a mean ejection fraction of 35% ± 9.53%. Propensity matching yielded a 1:1 match with 324 patients in each cohort, controlling for all baseline characteristics. Thirty-day mortality was similar for PCI versus CABG (6.2% vs 4.9%; P = .49). Overall mortality over the study follow-up period (median, 3.23 years; range, 1.83-4.98 years) was significantly higher for the PCI cohort (37.4% vs 21.3%; P < .001). Total hospital readmissions (24.1% vs 12.9%; P = .001), cardiac readmissions (20.4% vs 11.1%; P = .001), myocardial infarction event (7.7% vs 1.8%; P = .001), MACCE (41.4% vs 23.8%; P < .001), and repeat revascularization (6.5% vs 2.6%; P = .02) occurred more frequently in the PCI cohort. Freedom from MACCE at 1 year (74.4% vs 87.0%; P < .001) and 5 years (54.5% vs 74.0%; P < .001) was significantly lower for the PCI cohort. On multivariable cox regression analysis, CABG (hazard ratio, 0.57; 95% confidence interval, 0.44-0.73; P < .001) was significantly associated with improved survival. Prior liver disease, dialysis, diabetes, and peripheral artery disease were the most significant predictors of mortality. The cumulative incidence of hospital readmission was lower for the CABG cohort (hazard ratio, 0.51; 95% confidence interval, 0.37-0.71; P < .001). Multivariable cox regression for MACCE (hazard ratio, 0.48; 95% confidence interval, 0.39-0.58; P < .001) showed significantly fewer events for the CABG cohort.
Conclusions: Patients with reduced ejection fraction who underwent CABG had significantly improved survival, lower MACCE, and fewer repeat revascularization procedures compared with patients who underwent PCI.
(Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Comment in: J Thorac Cardiovasc Surg. 2021 Mar;161(3):1033-1034. (PMID: 32778463)
Comment in: J Thorac Cardiovasc Surg. 2021 Mar;161(3):1032-1033. (PMID: 32800361)

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