Bypass grafting versus stenting for patients with severely reduced ejection fraction – 2 Minute Medicine

1. Patients with severely reduced left ventricular ejection fraction with left main, left anterior descending, or multivessel disease who underwent percutaneous coronary intervention demonstrated higher rates of mortality and major adverse cardiovascular events compared to those who underwent coronary artery bypass grafting.

Evidence Rating Level:2 (Good)

There is insufficient evidence in the literature on outcomes of revascularization strategies for patients with severely reduced left ventricular ejection fraction (LVEF). This retrospective cohort study of patients in Ontario, Canada sought to determine whether or not outcomes differ between with severely reduced LVEF with left main coronary artery, left anterior descending artery, or multivessel disease who undergo percutaneous coronary intervention (PCI) and those who undergo coronary artery bypass grafting (CABG), including all-cause mortality and death from major adverse cardiovascular events (MACE). Data from 12,113 patients across both the PCI (mean [SD] age = 64.8 [11.0] years, 27.5% female) and CABG (mean [SD] age = 65.6 [9.7] years, 17.1% female) groups were utilized. Patients were propensity score-matched, resulting in 2,397 patients from each group with a median follow-up time of 5.2 years (IQR 5.0 to 5.3). Compared to CABG, researchers found that patients who underwent PCI demonstrated significantly greater mortality rates (HR 1.6, 05% CI 1.3 to 1.7), cardiovascular disease-related death (HR 1.4, 95% CI 1.1 to 1.6), subsequent revascularization (HR 3.7, 95% CI 3.2 to 4.3), MACE (HR 2.0, 95% CI 1.9 to 2.2), and hospitalization for either heart failure (HR 1.5, 95% CI 1.3 to 1.6), heart failure (HR 1.5, 95% CI 1.3 to 1.6), or myocardial infarction (HR 3.2, 95% CI 2.6 to 3.8). Overall, these findings suggest a need to strongly consider interventions for patients with severely reduced LVEF due to the elevated risks of mortality and MACE associated with PCI.

Click to read the study in JAMA Cardiology

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Bypass grafting versus stenting for patients with severely reduced ejection fraction - 2 Minute Medicine