Myocardial Revascularization in Patients with Coronary Artery Disease and Reduced Left Ventricular Ejection Fraction

Keywords: coronary artery disease, percutaneous coronary intervention, coronary artery bypass grafting, heart failure with reduced left ventricular ejection fraction, myocardial infarction, atherosclerotic lesion of coronary arteries, SYNTAX Score

Abstract

The aim. To evaluate the short-term and long-term outcomes of myocardial revascularization – percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) – in patients with coronary artery disease (CAD) and heart failure (HF) with reduced left ventricular ejection fraction.

Materials and methods. This one-center prospective study was conducted on the basis of the Ukrainian Children’s Cardiac Center, Clinic for Adults, Kyiv, Ukraine. Analysis included 194 patients with CAD and HF with reduced left ventricular ejection fraction. The studied cohort of patients underwent myocardial revascularization: 99 (51.1%) patients through PCI and 95 (48.9%) patients through CABG during 24 months (between January 2020 and January 2022).

Results and discussion. PCI and CAD were associated with a similar risk of all-cause mortality during 30-day follow-up (HR 0,95; [95% CI], 0.135-6.796; p=0.96). When analyzing the long-term results of myocardial revascularization in terms of the effect on all-cause mortality, PCI and CABG had identical results, no significant difference was observed (HR 1.05; [95% CI], 0.448-2.481; p = 0.903). However, PCI was associated with an increased risk of repeated myocardial revascularization (HR 3.00; [95% CI], 1.251-7.221; p=0.025) compared with CABG. Patients who underwent CABG had a significant difference in the number of re-hospitalizations due to HF progression compared to those after PCI (HR 0.33; [95% CI], 0.170-0.652; p=0.002). The rehabilitation period was 2±4 days in patients after PCI, and 7±4 days in patients after CABG, which corresponded to a statistically significant difference (HR 3.48; [95% CI], 2.489-4.891; p <0.001). The visual analog scale scores of pain intensity were 3±1 in patients after PCI and 7±2 in those after CABG, the difference is statistically significant (HR 3.16; [95% CI], 2.283-4.382; p <0.001).

Conclusions. Results of myocardial revascularization with PCI and CABG had identical short-term and long-term all-cause mortality rates. However, PCI was associated with a higher risk of repeated myocardial revascularization over a 2-year follow-up period. CABG, in turn, was associated with more frequent HF readmissions than PCI. The rehabilitation period was statistically shorter in patients after PCI. According to the visual analog scale, the pain in patients after CABG was more pronounced.

References

  1. Bangalore S, Guo Y, Samadashvili Z, Blecker S, Hannan EL. Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery. Circulation. 2016;133(22):2132-40. https://doi.org/10.1161/CIRCULATIONAHA.115.021168
  2. Bortnick AE, Epps KC, Selzer F, Anwaruddin S, Marroquin OC, Srinivas V, et al. Five-Year Follow-Up of Patients Treated for Coronary Artery Disease in the Face of an Increasing Burden of Co-Morbidity and Disease Complexity (from the NHLBI Dynamic Registry). Am J Cardiol. 2014;113(4):573-9. https://doi.org/10.1016/j.amjcard.2013.10.039
  3. Doshi D, Ben-Yehuda O, Bonafede M, Josephy N, Karmpaliotis D, Parikh MA, et al. Underutilization of Coronary Artery Disease Testing Among Patients Hospitalized With New-Onset Heart Failure. J Am Coll Cardiol. 2016;68(5):450-8. https://doi.org/10.1016/j.jacc.2016.05.060
  4. Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J, Brooks MM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet. 2009;373(9670):1190-7. https://doi.org/10.1016/S0140-6736(09)60552-3.
  5. Mamas MA, Anderson SG, O’Kane PD, Keavney B, Nolan J, Oldroyd KG, et al. Impact of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. Eur Heart J. 2014;35(43):3004-12a. https://doi.org/10.1093/eurheartj/ehu303
  6. Marui A, Kimura T, Nishiwaki N, Mitsudo K, Komiya T, Hanyu M, et al. Comparison of Five-Year Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in patients With Left Ventricular Ejection Fractions ≤50% Versus >50% (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). Am J Cardiol. 2014;114(7):988-96. https://doi.org/10.1016/j.amjcard.2014.07.007
  7. Pei J, Wang X, Xing Z, Zheng K, Hu X. Short-term and long-term outcomes of revascularization interventions for patients with severely reduced left ventricular ejection fraction: a meta-analysis. ESC Heart Fail. 2021;8(1):634-43. https://doi.org/10.1002/ehf2.13141
  8. Perera D, Clayton T, Petrie MC, Greenwood JP, O’Kane PD, Evans R, et al. Percutaneous Revascularization for Ischemic Ventricular Dysfunction: Rationale and Design of the REVIVED-BCIS2 Trial: Percutaneous Coronary Intervention for Ischemic Cardiomyopathy. JACC Heart Fail. 2018;6(6):517-26. https://doi.org/10.1016/j.jchf.2018.01.024
  9. Shore S, Grau-Sepulveda MV, Bhatt DL, Heidenreich PA, Eapen ZJ, Hernandez AF, et al. Characteristics, Treatments, and Outcomes of Hospitalized Heart Failure Patients Stratified by Etiologies of Cardiomyopathy. JACC Heart Fail. 2015;3(11):906-16. https://doi.org/10.1016/j.jchf.2015.06.012
  10. Ståhle E, Bergström R, Edlund B, Frostfeldt G, Lagerquist B, Sjögren I, et al. Influence of Left Ventricular Function on Survival After Coronary Artery Bypass Grafting. Ann Thorac Surg. 1997;64(2):437-44. https://doi.org/10.1016/s0003-4975(97)00536-5
  11. Sun LY, Gaudino M, Chen RJ, Bader Eddeen A, Ruel M. Long-term Outcomes in Patients With Severely Reduced Left Ventricular Ejection Fraction Undergoing Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting. JAMA Cardiol. 2020;5(6):631-41. https://doi.org/10.1001/jamacardio.2020.0239. Erratum in: JAMA Cardiol. 2020 Jun 1;5(6):732.
  12. Velazquez EJ, Lee KL, Deja MA, Jain A, Sopko G, Marchenko A, et al.; STICH Investigators. Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction. N Engl J Med. 2011;364(17):1607-16. https://doi.org/10.1056/NEJMoa1100356
  13. Velazquez EJ, Lee KL, Jones RH, Al-Khalidi HR, Hill JA, Panza JA, et al.; STICHES Investigators. Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy. N Engl J Med. 2016;374(16):1511-20. https://doi.org/10.1056/NEJMoa1602001
  14. Yang JH, Choi SH, Song YB, Hahn JY, Choi JH, Jeong DS, et al. Long-Term Outcomes of Drug-Eluting Stent Implantation Versus Coronary Artery Bypass Grafting for Patients With Coronary Artery Disease and Chronic Left Ventricular Systolic Dysfunction. Am J Cardiol. 2013;112(5):623-9. https://doi.org/10.1016/j.amjcard.2013.04.035
Published
2022-09-26
How to Cite
Kucheriava, M. V., & Mankovsky, G. B. (2022). Myocardial Revascularization in Patients with Coronary Artery Disease and Reduced Left Ventricular Ejection Fraction. Ukrainian Journal of Cardiovascular Surgery, 30(3), 44-49. https://doi.org/10.30702/ujcvs/22.30(03)/KM042-4449