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PCI promotes higher mortality rates than CABG in patients with reduced left ventricular ejection fraction

Key clinical point: Mortality and major adverse cardiovascular events were more commend in patients with reduced left ventricular ejection fraction who underwent percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG).

Major finding: All-cause mortality was significantly higher in adults with reduced LVEF who underwent PCI compared with CABG (hazard ratio 1.6).

Study details: The data come from a retrospective study of 12,113 adults with a mean age of 65 years with LVEFs less than 35%.

Disclosures: The study was supported by the Institute for Clinical Evaluative Sciences (ICES), the University of Ottawa, the University of Ottawa Heart Institute, and the Ottawa Heart Institute Research Corporation The researchers had no financial conflicts to disclose.

Commentary

“Societal guidelines differ in their recommendation of revascularization strategy for patients with ischemic cardiomyopathy. This retrospective cohort study from Ontario, Canada compared long-term outcomes in patients with severely reduced left ventricular ejection fraction (LVEF<35%) with left anterior descending (LAD), left main, or multivessel coronary artery disease (with or without LAD involvement) who underwent either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Analyses of two groups of 2397 propensity score matched patients were performed with median follow-up of 5.2 years.

Patients who underwent PCI had significantly higher rates of mortality (hazard ratio [HR], 1.6; 95% CI, 1.3-1.7), death from cardiovascular disease (HR 1.4, 95% CI, 1.1-1.6), MACE (HR, 2.0; 95% CI, 1.9-2.2), subsequent revascularization (HR, 3.7; 95% CI, 3.2-4.3), and hospitalization for MI (HR, 3.2; 95% CI, 2.6-3.8) and heart failure (HR, 1.5; 95% CI, 1.3-1.6) compared with those who underwent CABG. This study demonstrates that CABG may be associated with better outcomes among patients with severely reduced LVEF who require revascularization. This finding should be incorporated in the decision making for these groups of patients.”

Luke Kim, MD

Weill Cornell Medical College/New York Presbyterian Hospital

Citation:

Sun LY et al. JAMA Cardiol. 2020 April 8. doi: 10.1001/jamacardio.2020.0239.