Abstract 14710: Prognostic Impact of Coronary Revascularization Therapy in Patients With Ischemic Heart Failure
Background: Coronary revascularization therapy, including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), is indicated to improve ventricular function and long-term prognosis of patients with ischemic heart failure (IHF). However, it remains to be examined which strategy is more useful in IHF patients, especially with a reference to diabetes mellitus (DM).
Methods and Results: We examined 2,232 consecutive IHF patients with stage C/D HF (73±11[SD] years, M/F 1,749/483) in our CHART-2 Registry, where 754 (34%) had DM. Their BNP levels and eGFR were 179±285 pg/ml and 59±25 ml/min/1.73m2, respectively. Before the enrollment, PCI and CABG had been performed in 1,294 (58%) and 430 (19%), respectively, while the remaining 508 (23%) had no history of revascularization. During the 3.1±1.2 years of follow-up, Kaplan-Meier analysis revealed that in the non-DM patients, crude all-cause mortality of the PCI group was significantly lower compared with the CABG or the non-revascularization group (log-rank test; PCI vs. CABG, P<0.01), whereas in the DM patients, the prognoses of the PCI and CABG groups were comparable and better compared with the non-revascularization group (PCI vs. CABG, P=0.69) (Figure ). Cox hazard model adjusted by age, sex, comorbidities (hypertension, hyperlipidemia), hemoglobin, eGFR, BNP, LVEF and medications (ACE inhibitor/ARB, β-blocker, statin) demonstrated that in the non-DM patients, only PCI was an independent positive predictor for all-cause mortality (PCI: HR[95%CI] 0.68[0.49-0.96], CABG: 0.88[0.59-1.32]), whereas in the DM patients, no superiority of PCI or CABG was noted to non-revascularization (PCI: HR[95%CI] 0.84[0.49-1.42], CABG: 0.96[0.51-1.83]).
Conclusions: These results indicate the different prognostic impact of revascularization therapy in stage C/D IHF patients, depending on the revascularization mode and the presence or absence of DM.
- © 2013 by American Heart Association, Inc.