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Heart. 2018 Sep 12. pii: heartjnl-2018-313242. doi: 10.1136/heartjnl-2018-313242. [Epub ahead of print]

Coronary artery bypass graft versus percutaneous coronary intervention in acute heart failure.

Author information

1
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
3
Sungkyunkwan University College of Medicine, Seoul, Korea.
4
Chungbuk National University College of Medicine, Cheongju, Korea.
5
Kyungpook National University College of Medicine, Daegu, Korea.
6
The Catholic University of Korea, Seoul, Korea.
7
Yonsei University College of Medicine, Seoul, Korea.
8
Seoul National University Bundang Hospital, Seongnam, Korea.
9
Yonsei University Wonju College of Medicine, Wonju, Korea.
10
Heart Research Center of Chonnam National University, Gwangju, Korea.

Abstract

OBJECTIVE:

Myocardial ischaemia is a leading cause of acute heart failure (AHF). However, optimal revascularisation strategies in AHF are unclear. We aimed to compare two revascularisation strategies, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), in patients with AHF.

METHODS:

Among 5625 consecutive patients enrolled prospectively in the Korean Acute Heart Failure registry from March 2011 to February 2014, 717 patients who received CABG or PCI during the index hospitalisation for AHF were included in this analysis. We compared adverse outcomes (death, rehospitalisation for HF aggravation or cardiovascular causes, ischaemic stroke and a composite outcome of death and rehospitalisation for HF aggravation or cardiovascular causes) with the use of propensity score matching.

RESULTS:

For the propensity score-matched cohort with 190 patients, CABG had a lower risk of all-cause mortality than PCI (83 vs 147 deaths per 1000 patient-years; HR 0.57, 95% CI 0.34 to 0.96, p=0.033) during the median follow-up of 4 years. There was also a trend towards lower rates of rehospitalisation due to cardiovascular events or HF aggravation. Subgroup analysis revealed that the adverse outcomes were significantly lower in the CABG group than in PCI group, especially in patients with old age, three-vessel diseases, significant proximal left anterior descending artery disease and those without left main vessel disease or chronic total occlusion.

CONCLUSIONS:

Compared with PCI, CABG is associated with significant lower all-cause mortality in patients with AHF. Further studies should evaluate proper revascularisation strategies in AHF.

CLINICAL TRIAL REGISTRATION:

NCT01389843; Results.

KEYWORDS:

coronary artery disease surgery; heart failure; percutaneous coronary intervention

PMID:
30209124
DOI:
10.1136/heartjnl-2018-313242
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