Prof. Elmir Omerovic, MD- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg speaks about Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).
Link to Abstract:
The goal of this study was to evaluate coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) for the treatment of heart failure caused by ischemic heart disease.
Methods and outcomes:
We looked at all-cause mortality after CABG or PCI in patients with heart failure and multivessel disease (coronary artery stenosis >50 percent in two arteries or the left main) who had coronary angiography in Sweden between 2000 and 2018. To account for known and unknown confounders, we utilized propensity score-adjusted logistic and Cox proportional-hazards regressions, as well as an instrumental variable model. In a hierarchical database, multilevel modeling was employed to account for clustering of observations. There were 2509 patients in all, with 82.9 percent of them being men; 35.8% of them had diabetes, and 34.7 percent had experienced a previous myocardial infarction. The average age was 68.1 9.4 years (47.8% were over 70), and 64.9 percent of the participants had three-vessel or left main illness. PCI was the primary indicated therapy in 56.2 percent of cases, while CABG was the primary designated therapy in 43.8 percent. The median period between follow-ups was 3.9 years (range: 1 day to 10 years). There were a total of 1010 deaths. CABG was associated with a decreased risk of death compared to PCI [odds ratio (OR) 0.62; 95 percent confidence interval (CI) 0.41–0.96; P = 0.031]. Death risk increased linearly with quintiles of hospitals where PCI was the preferred revascularization procedure (OR 1.27, 95 percent CI 1.17–1.38, Ptrend 0.001).
Long-term survival was higher following CABG than after PCI in patients with ischemic heart failure.