Coronary artery bypass grafting vs. percutaneous coronary intervention in severe ischaemic cardiomyopathy: long-term survival

Jason E Bloom; Sara Vogrin; Christopher M Reid; Andrew E Ajani; David J Clark; Melanie Freeman; Chin Hiew; Angela Brennan; Diem Dinh; Jenni Williams-Spence; Luke P Dawson; Samer Noaman; Derek P Chew; Ernesto Oqueli; Nicholas Cox; David McGiffin; Silvana Marasco; Peter Skillington; Alistair Royse; Dion Stub; David M Kaye; William Chan

doi:10.1093/eurheartj/ehae672

Coronary artery bypass grafting vs. percutaneous coronary intervention in severe ischaemic cardiomyopathy: long-term survival

Eur Heart J. 2024 Oct 29:ehae672. doi: 10.1093/eurheartj/ehae672. Online ahead of print.

Authors

Jason E Bloom^{1

2

3

4}, Sara Vogrin⁵, Christopher M Reid^{4

6}, Andrew E Ajani⁷, David J Clark⁸, Melanie Freeman⁹, Chin Hiew¹⁰, Angela Brennan⁴, Diem Dinh³, Jenni Williams-Spence⁴, Luke P Dawson^{2

4}, Samer Noaman¹¹, Derek P Chew¹², Ernesto Oqueli^{13

14}, Nicholas Cox¹¹, David McGiffin¹⁵, Silvana Marasco¹⁵, Peter Skillington¹⁶, Alistair Royse^{5

16}, Dion Stub^{2

4}, David M Kaye^{2

3}, William Chan^{2

3

5

11}

Affiliations

¹ Cardiology Division, Columbia University Medical Center, 161 Fort Washington Ave, Herbert Irving Pavilion, 6th Floor, New York, NY 10032, USA.
² Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia.
³ Heart Failure Research Group, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.
⁴ School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Road, Melbourne, VIC 3004, Australia.
⁵ Melbourne Medical School, University of Melbourne, Grattan Street, Melbourne, VIC 3010, Australia.
⁶ School of Population Health, Curtin University, Kent Street, Perth, WA 6102, Australia.
⁷ Department of Cardiology, The Royal Melbourne Hospital, Grattan Street, Melbourne, VIC 3010, Australia.
⁸ Department of Cardiology, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia.
⁹ Department of Cardiology, Eastern Health, 8 Arnold Street, Box Hill, VIC 3128, Australia.
¹⁰ Department of Cardiology, University Hospital Geelong, Bellarine Street, Geelong, VIC 3220, Australia.
¹¹ Department of Cardiology, Western Health, Furlong Road, St Albans, VIC 3021, Australia.
¹² Victorian Heart Institute, Monash University, Melbourne, Australia.
¹³ Department of Cardiology, Grampians Health Ballarat, 1 Drummond Street N, Ballarat, Central VIC 3350, Australia.
¹⁴ Faculty of Health, School of Medicine, Deakin University, Geelong, VIC, Australia.
¹⁵ Department of Cardiothoracic Surgery, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia.
¹⁶ Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Grattan Street, Melbourne, VIC 3010, Australia.

PMID: 39471463
DOI: 10.1093/eurheartj/ehae672

Abstract

Background and aims: The optimal revascularization strategy in patients with ischaemic cardiomyopathy remains unclear with no contemporary randomized trial data to guide clinical practice. This study aims to assess long-term survival in patients with severe ischaemic cardiomyopathy revascularized by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).

Methods: Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons and Melbourne Interventional Group registries (from January 2005 to 2018), patients with severe ischaemic cardiomyopathy [left ventricular ejection fraction (LVEF) <35%] undergoing PCI or isolated CABG were included in the analysis. Those with ST-elevation myocardial infarction and cardiogenic shock were excluded. The primary outcome was long-term National Death Index-linked mortality up to 10 years following revascularization. Risk adjustment was performed to estimate the average treatment effect using propensity score analysis with inverse probability of treatment weighting (IPTW).

Results: A total of 2042 patients were included, of whom 1451 patients were treated by CABG and 591 by PCI. Inverse probability of treatment weighting-adjusted demographics, procedural indication, coronary artery disease extent, and LVEF were well balanced between the two patient groups. After risk adjustment, patients treated by CABG compared with those treated by PCI experienced reduced long-term mortality [adjusted hazard ratio 0.59, 95% confidence interval (CI) 0.45-0.79, P = .001] over a median follow-up period of 4.0 (inter-quartile range 2.2-6.8) years. There was no difference between the groups in terms of in-hospital mortality [adjusted odds ratio (aOR) 1.42, 95% CI 0.41-4.96, P = .58], but there was an increased risk of peri-procedural stroke (aOR 19.6, 95% CI 4.21-91.6, P < .001) and increased length of hospital stay (exponentiated coefficient 3.58, 95% CI 3.00-4.28, P < .001) in patients treated with CABG.

Conclusions: In this multi-centre IPTW analysis, patients with severe ischaemic cardiomyopathy undergoing revascularization by CABG rather than PCI showed improved long-term survival. However, future randomized controlled trials are needed to confirm the effect of any such benefits.

Keywords: CABG; Heart failure; Ischaemic cardiomyopathy; PCI; Revascularization.

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Abstract

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