TY - JOUR
T1 - Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients with Reduced Ejection Fraction and Coronary Artery Disease
T2 - A Meta-Analysis
AU - Wolff, Georg
AU - Dimitroulis, Dimitrios
AU - Andreotti, Felicita
AU - Kołodziejczak, Michalina
AU - Jung, Christian
AU - Scicchitano, Pietro
AU - Devito, Fiorella
AU - Zito, Annapaola
AU - Occhipinti, Michele
AU - Castiglioni, Battistina
AU - Calveri, Giuseppe
AU - Maisano, Francesco
AU - Ciccone, Marco M.
AU - De Servi, Stefano
AU - Navarese, Eliano P.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background - Heart failure with reduced ejection fraction caused by ischemic heart disease is associated with increased morbidity and mortality. It remains unclear whether revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) carries benefits or risks in this group of stable patients compared with medical treatment. Methods and Results - We performed a meta-analysis of available studies comparing different methods of revascularization (PCI or CABG) against each other or medical treatment in patients with coronary artery disease and left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality; myocardial infarction, revascularization, and stroke were also analyzed. Twenty-one studies involving a total of 16 191 patients were included. Compared with medical treatment, there was a significant mortality reduction with CABG (hazard ratio, 0.66; 95% confidence interval, 0.61-0.72; P<0.001) and PCI (hazard ratio, 0.73; 95% confidence interval, 0.62-0.85; P<0.001). When compared with PCI, CABG still showed a survival benefit (hazard ratio, 0.82; 95% confidence interval, 0.75-0.90; P<0.001). Conclusions - The present meta-analysis indicates that revascularization strategies are superior to medical treatment in improving survival in patients with ischemic heart disease and reduced ejection fraction. Between the 2 revascularization strategies, CABG seems more favorable compared with PCI in this particular clinical setting.
AB - Background - Heart failure with reduced ejection fraction caused by ischemic heart disease is associated with increased morbidity and mortality. It remains unclear whether revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) carries benefits or risks in this group of stable patients compared with medical treatment. Methods and Results - We performed a meta-analysis of available studies comparing different methods of revascularization (PCI or CABG) against each other or medical treatment in patients with coronary artery disease and left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality; myocardial infarction, revascularization, and stroke were also analyzed. Twenty-one studies involving a total of 16 191 patients were included. Compared with medical treatment, there was a significant mortality reduction with CABG (hazard ratio, 0.66; 95% confidence interval, 0.61-0.72; P<0.001) and PCI (hazard ratio, 0.73; 95% confidence interval, 0.62-0.85; P<0.001). When compared with PCI, CABG still showed a survival benefit (hazard ratio, 0.82; 95% confidence interval, 0.75-0.90; P<0.001). Conclusions - The present meta-analysis indicates that revascularization strategies are superior to medical treatment in improving survival in patients with ischemic heart disease and reduced ejection fraction. Between the 2 revascularization strategies, CABG seems more favorable compared with PCI in this particular clinical setting.
KW - coronary artery bypass
KW - coronary artery disease
KW - heart failure
KW - meta-analysis
KW - myocardial infarction
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U2 - 10.1161/CIRCHEARTFAILURE.116.003255
DO - 10.1161/CIRCHEARTFAILURE.116.003255
M3 - Article
C2 - 28087687
AN - SCOPUS:85010066700
VL - 10
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
SN - 1941-3297
IS - 1
M1 - e003255
ER -