Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Patients with Left Ventricular Systolic Dys
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REVIEW ARTICLE
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Patients with Left Ventricular Systolic Dysfunction Mahin R. Khan 1 & Waleed T. Kayani 2 & Jason Pelton 2 & Ahmed Ansari 2 & David Paniagua 2 & Umair Khalid 2,3 & Ali Denktas 2 & Hameem U. Changezi 1 & Ahmad Munir 1 & Ernesto Jimenez 3,4 & Mahboob Alam 2 & Hani Jneid 2,3 Accepted: 24 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose There is a paucity of comparative data examining the optimal revascularization strategy in patients with left ventricular systolic dysfunction (LVD). Methods We performed an aggregate data meta-analysis of clinical outcomes comparing percutaneous coronary intervention (PCI) versus coronary artery bypass (CABG) in patients with LVD (left ventricle ejection fraction (LVEF) of ≤ 40%), using the random effects model. Effects size is reported as odds ratio (OR) and a 95% confidence interval. Outcomes included all-cause mortality, myocardial infarction, stroke, repeat revascularization, and a composite of major adverse cardiac and cerebrovascular events (MACCE) at 30-day, 3-year, and long-term (6.3 ± 0.9 years) follow-ups. Seventeen studies (16 observational, 1 randomized) and 18,599 patients (CABG 9651; PCI 8948) were included. Results PCI and CABG had comparable all-cause mortality at 30 days (OR 0.78, 95% CI 0.49–1.23) and 3 years (OR 1.05, 95% CI 0.91–1.21); however, PCI was associated with increased long-term morality after a mean follow-up of 6.3 ± 0.9 years (31.6% vs. 24.3%, OR 1.41, 95% CI 1.21–1.64). A similar mortality trend was observed in the subgroup of patients with EF ≤ 35%. PCI had a higher rate of repeat revascularization at 3-year and long-term follow-ups. The longterm rates of stroke and MI were comparable. PCI, on the other hand, had lower rates of stroke at 30-day and 3-year follow-ups. Conclusion CABG was associated with lower rates of long-term mortality and revascularization but higher rate of upfront stroke in patients with LVD. However, the data included consisted predominantly of observational studies, highlighting the paucity and need for randomized trials. Keywords Percutaneous coronaryintervention . Coronary arterybypass . Left ventricular systolic dysfunction . Cardiomyopathy . Revascularization . Ejection fraction
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10557-020-07063-0) contains supplementary material, which is available to authorized users. * Hani Jneid [email protected] 1
Division of Cardiology, McLaren-Flint/Michigan State University, Flint, MI, USA
2
Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77030, USA
3
Division of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
4
Division of Cardiothoracic Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
Ischemic heart disease is the leading cause of global cardiovascular mortality, with a
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