Outcomes after percutaneous coronary intervention or bypass surgery for ischemic cardiomyopathy

Abstract

Introduction and objectives: There are 2 options to achieve revascularization in ischemic cardiomyopathy: percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). While the benefits of PCI for ischemic cardiomyopathy are unclear, achieving complete revascularization with PCI could improve outcomes comparable to CABG.

Methods: A total of 1496 patients with left ventricular ejection fraction (LVEF) <50% and multivessel disease who underwent either PCI or CABG were selected from a single-center cohort registry. They were divided into the PCI with complete revascularization (n=188), the PCI with incomplete revascularization (n=263), and the CABG group (n=1045), and then compared. The primary outcome was a 5-year composite of cardiac death or myocardial infarction.

Results: A total of 1496 patients treated for ischemic cardiomyopathy was stratified into CABG (n=1045) and PCI (n=451) groups, the latter subdivided into complete (n=188) or incomplete revascularization (n=263). PCI showed a higher incidence of the primary outcome compared with CABG (PCI vs CABG, 27.8% vs 22.2%, adjusted HR, 1.35; 95%CI, 1.05-1.73, P=.019). However, PCI with complete revascularization and CABG had similar incidences of the primary outcome (20.5% vs 22.2%, adjusted HR, 1.07; 95%CI, 0.73-1.57; P=.718).

Conclusions: CABG is associated with more favorable clinical outcomes than PCI in patients with ischemic cardiomyopathy. However, achieving complete revascularization with PCI could improve outcomes comparable to CABG.

Keywords: Cirugía de revascularización coronaria; Coronary artery bypass graft; Heart failure; Insuficiencia cardiaca; Intervención coronaria percutánea; Ischemic cardiomyopathy; Miocardiopatía isquémica; Percutaneous coronary intervention.