Abstract 12304: Impact of Coronary Artery Bypass Surgery in Patients With Ischemic Heart Failure: 5-Year Outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2
Background: Ischemic heart disease is a major risk factor for heart failure. However, long-term benefit of PCI or CABG on ischemic heart failure with complex coronary disease has not been well elucidated.
Methods and Results: We identified 1227 patients with multivessel and/or left main disease with a history of heart failure (ACC/AHA stage C or D) of 15,939 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. There were 807 patients undergoing PCI (DES: 75%) and 420 CABG. Preprocedural LVEF was not different between PCI and CABG (45.9±15.2% vs. 46.1±14.7%, p=0.83), but the CABG group included more patients with triple-vessel (51% vs. 79%, p≤0.01) and left main disease (9.4% vs. 31%, p≤0.01). [Table] Five-year outcomes revealed that the risk of hospital readmission for heart failure was higher after PCI than CABG (hazard ratio [95% confidence interval]; 1.59 [1.17-2.16], p≤0.01). Most importantly, all-cause mortality after PCI was significantly higher than CABG (1.59 [1.23-2.06], p≤0.01). Specifically, the risk of arrhythmia-related death was far higher after PCI (6.49 [1.99-21.3], p≤0.01). The risk of myocardial infarction was also higher after PCI (1.87 [1.20-2.92], p≤0.01); however, the risk of stroke was not different between PCI and CABG (1.26 [0.82-1.94], p=0.28). Stratified analysis using the SYNTAX score demonstrated that risk for death was not different between PCI and CABG in patients with low (≤23) SYNTAX score (0.87 [0.37-2.05], p=0.75), whereas those with intermediate (23 to 32) and high (≥33) SYNTAX score, risk for death was significantly higher after PCI (2.01 [1.13-3.57], p=0.02 and 2.35 [1.16-4.78], p=0.02).
Conclusions: In patients with ischemic heart failure with complex coronary disease, CABG was better option than PCI because CABG was associated with better survival benefit and quality of life, particularly in more complex coronary lesion stratified by the SYNTAX score.
- © 2013 by American Heart Association, Inc.