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      Therapeutics and Clinical Risk Management (submit here)

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      Clinical Outcomes of Patients with Coronary Artery Diseases and Moderate Left Ventricular Dysfunction: Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Surgery


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          Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are two revascularization strategies for patients with coronary artery disease (CAD) and left ventricular dysfunction. However, the comparisons of effectiveness between the two strategies are insufficient. This study is aimed to compare the effectiveness between PCI and CABG among patients with moderate left ventricular dysfunction.

          Patients and Methods

          A total of 1487 CAD patients with moderate reduced ejection fraction (36%≤EF≤40%), who underwent either PCI or CABG, were enrolled in a real-world cohort study (No. ChiCTR2100044378). Clinical outcomes included short- and long-term all-cause mortality, rates of heart failure (HF) hospitalization and repeat revascularization. Propensity score matching was used to balance the two cohorts.


          PCI was associated with lower 30-day mortality rate (hazard ratio [HR] [95% CI], 0.35 [0.15–0.83]; P=0.02). At a mean follow-up of 4.5 years, PCI and CABG had similar all-cause death (HR [95% CI], 0.82 [0.56–1.20]; P=0.30) and heart failure (HF) hospitalization (HR [95% CI], 0.93 [0.54–1.60]; P=0.79), but PCI had higher risk of repeat revascularization (HR [95% CI], 8.62 [3.67–20.23]; P<0.001). Improvement in EF measured at 3 months later after revascularization was also similar between PCI and CABG ( P for interaction=0.87).


          CAD patients with moderate reduced EF who had PCI had lower short-term mortality rate but higher risk of repeat revascularization during follow-up than patients who had CABG. PCI showed comparable long-term survival, HF hospitalization risk, and EF improvement.

          Most cited references32

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          2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

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            Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy.

            The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear.
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              2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.


                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                15 October 2021
                : 17
                : 1103-1111
                [1 ]Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University , Beijing, People’s Republic of China
                [2 ]Division of Health Care Delivery Research, Mayo Clinic , Rochester, MN, USA
                [3 ]Department of Anesthesiology, Minhang Hospital, Fudan University , Shanghai, People’s Republic of China
                [4 ]Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic , Rochester, MN, USA
                Author notes
                Correspondence: Bijan J Borah, Department of Health Sciences Research, Mayo Clinic , 200 First St SW, Rochester, MN, 55905, USA Email borah.bijan@mayo.edu
                Jinghua Liu Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University , No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, People’s Republic of China Tel/Fax +86 10 64456998 Email liujinghua@vip.sina.com
                © 2021 Wang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                : 01 September 2021
                : 28 September 2021
                Page count
                Figures: 2, Tables: 8, References: 32, Pages: 9
                Funded by: National Basic Research Program of China;
                This work was supported by the National Basic Research Program of China (973 Program, 2015CB554404).
                Original Research

                bypass,ejection fraction,heart failure,revascularization,stents
                bypass, ejection fraction, heart failure, revascularization, stents


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