Preferred Revascularization Strategies in Patients with Ischemic Heart Failure: A Meta-Analysis

• Published in: Current medical science Vol. 38; no. 5; pp. 776 - 784
• Main Authors: Xiao, Jie, Xu, Fen, Yang, Chuan-lei, Chen, Wei-qiang, Chen, Xing, Zhang, Hua, Wei, Zhan-jie, Liu, Jin-ping
• Format: Journal Article
• Language: English
• Published: Wuhan Huazhong University of Science and Technology 01.10.2018
• Subjects: Coronary Artery Bypass; Drug-Eluting Stents; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart Failure - surgery; Humans; Medicine; Medicine & Public Health; Myocardial Infarction - drug therapy; Myocardial Infarction - physiopathology; Myocardial Infarction - surgery; Myocardial Ischemia - drug therapy; Myocardial Ischemia - physiopathology; Myocardial Ischemia - surgery; Myocardial Revascularization - methods; Percutaneous Coronary Intervention; Proportional Hazards Models; coronary artery disease; percutaneous coronary intervention; ischemic heart failure; left ventricular ejection fraction; coronary artery bypass grafting
• ISSN: 2096-5230; 2523-899X
• DOI: 10.1007/s11596-018-1944-8

Clinically, coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is generally used to treat patients with ischemic heart failure. However, the optimal treatment strategy remains unknown. This study examined the efficacy of the two coronary revascularization strategies for severe ischemic heart failure by using a meta-analysis. Studies comparing the efficacy of CABG and PCI were obtained from PubMed, EMBASE, Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL). The quality of each eligible article was evaluated by Newcastle-Ottawa Quality Assessment Scale (NOS), and the meta-analysis was performed using Stata version 12.0 software. Eventually, 12 studies involving 9248 patients ( n =4872 in CABG group; n =4376 in PCI group) were subject to the meta-analysis for subsequent pooling calculation. The pooled hazard ratio (HR) [HR=0.83, 95% CI (0.76, 0.90), P <0.001; heterogeneity, P =0.218, I 2 =22.9%] of CABG compared with that of PCI revealed a statistical superiority of CABG to PCI in terms of the long-term mortality. Furthermore, CABG showed more advantages over PCI with respect to the incidence of myocardial infarction [HR=0.51, 95% CI (0.39, 0.67), P <0.001; heterogeneity, P =0.707, I 2 =0%] and repeat revascularization [HR=0.40, 95% CI (0.27, 0.59), P <0.001; heterogeneity, P <0.001, I 2 =80.1%]. It was concluded that CABG appears to be more advantageous than PCI for the treatment of ischemic heart failure in the given clinical setting.