Three-year outcomes after percutaneous coronary intervention and coronary artery bypass grafting in patients with heart failure: from the CREDO-Kyoto percutaneous coronary intervention/coronary artery bypass graft registry cohort-2

OBJECTIVES Ischaemic heart disease is a major risk factor for heart failure. However, long-term benefit of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in those patients has not been well elucidated. METHODS Of the 15 939 patients undergoing first myocardial rev...

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Published in:European journal of cardio-thoracic surgery 2015-02, Vol.47 (2), p.316-321
Main Authors: Marui, Akira, Kimura, Takeshi, Nishiwaki, Noboru, Komiya, Tatsuhiko, Hanyu, Michiya, Shiomi, Hiroki, Tanaka, Shiro, Sakata, Ryuzo
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Coronary Artery Bypass - mortality
Female
Follow-Up Studies
Heart Failure - epidemiology
Heart Failure - surgery
Humans
Japan - epidemiology
Male
Percutaneous Coronary Intervention - mortality
Ventricular Dysfunction, Left - surgery
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Summary:OBJECTIVES Ischaemic heart disease is a major risk factor for heart failure. However, long-term benefit of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in those patients has not been well elucidated. METHODS Of the 15 939 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2, we identified 1064 patients with multivessel and/or left main disease with a history of heart failure (ACC/AHA Stage C or D). RESULTS There were 672 patients undergoing PCI and 392 CABG. Preprocedural left ventricular ejection fraction was not different between PCI and CABG (46.6 ± 15.1 vs 46.6 ± 14.6%, P = 0.89), but the CABG group included more patients with triple-vessel and left main disease (P < 0.01 each). Three-year outcomes revealed that the risk of hospital readmission for heart failure was higher after PCI than after CABG (hazard ratio [95% confidence interval]; 1.90 [1.18–3.05], P = 0.01). More importantly, adjusted mortality after PCI was significantly higher than after CABG (1.79 [1.13–2.82], P = 0.01). The risk of cardiac death after PCI was also higher than after CABG (1.98 [1.10–3.55], P = 0.02). Stratified analysis using the SYNTAX score demonstrated that risk of death was not different between PCI and CABG in patients with low (
ISSN:1010-7940
1873-734X
DOI:10.1093/ejcts/ezu131