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Comparison of Five-Year Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Patients With Left Ventricular Ejection Fractions ≤50% Versus >50% (from the CREDO-Kyoto PCI/CABG Registry Cohort-2)

      Highlights

      • Outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were compared in patients with ejection fractions (EFs) ≤50% versus >50%.
      • Similar outcomes were found between PCI and CABG in patients with EF >50%.
      • CABG had a better survival rate than PCI in patients with EF ≤50%.
      • Further study is warranted in patients with severe LV systolic dysfunction (EF ≤35%).
      Coronary heart disease is a major risk factor for left ventricular (LV) systolic dysfunction. However, limited data are available regarding long-term benefits of percutaneous coronary intervention (PCI) in the era of drug-eluting stent or coronary artery bypass grafting (CABG) in patients with LV systolic dysfunction with severe coronary artery disease. We identified 3,584 patients with 3-vessel and/or left main disease of 15,939 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Of them, 2,676 patients had preserved LV systolic function, defined as an LV ejection fraction (LVEF) of >50% and 908 had impaired LV systolic function (LVEF ≤50%). In patients with preserved LV function, 5-year outcomes were not different between PCI and CABG regarding propensity score–adjusted risk of all-cause and cardiac deaths. In contrast, in patients with impaired LV systolic function, the risks of all-cause and cardiac deaths after PCI were significantly greater than those after CABG (hazard ratio 1.49, 95% confidence interval 1.04 to 2.14, p = 0.03 and hazard ratio 2.39, 95% confidence interval 1.43 to 3.98, p <0.01). In both patients with moderate (35% < LVEF ≤ 50%) and severe (LVEF ≤35%) LV systolic dysfunction, the risk of cardiac death after PCI was significantly greater than that after CABG (hazard ratio 2.25, 95% confidence interval 1.15 to 4.40, p = 0.02 and hazard ratio 4.42, 95% confidence interval 1.48 to 13.24, p = 0.01). Similarly, the risk of all-cause death tended to be greater after PCI than after CABG in both patients with moderate and severe LV systolic dysfunction without significant interaction (hazard ratio 1.57, 95% confidence interval 0.96 to 2.56, p = 0.07 and hazard ratio 1.42, 95% confidence interval 0.71 to 2.82, p = 0.32; interaction p = 0.91). CABG was associated with better 5-year survival outcomes than PCI in patients with impaired LV systolic function (LVEF ≤50%) with complex coronary disease in the era of drug-eluting stents. In both patients with moderate (35% < LVEF ≤ 50%) and severe (LVEF ≤35%) LV systolic dysfunction, CABG tended to have better survival outcomes than PCI.
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      References

        • Adams K.F.
        • Fonarow G.C.
        • Emerman C.L.
        • LeJemtel T.H.
        • Costanzo M.R.
        • Abraham W.T.
        • Berkowitz R.L.
        • Galvao M.
        • Horton D.P.
        • Investiga A.S.A.C.
        Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000, cases in the Acute Decompensated Heart Failure National Registry (ADHERE).
        Am Heart J. 2005; 149: 209-216
        • Hunt S.A.
        • Abraham W.T.
        • Chin M.H.
        • Feldman A.M.
        • Francis G.S.
        • Ganiats T.G.
        • Jessup M.
        • Konstam M.A.
        • Mancini D.M.
        • Michl K.
        • Oates J.A.
        • Rahko P.S.
        • Silver M.A.
        • Stevenson L.W.
        • Yancy C.W.
        2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the International Society for Heart and Lung Transplantation.
        J Am Coll Cardiol. 2009; 53: e1-e90
        • Yaku H.
        • Doi K.
        • Okawa K.
        Surgical management of ischemic mitral regurgitation: indications, procedures, and future prospects.
        Gen Thorac Cardiovasc Surg. 2013; 61: 497-503
        • Appoo J.
        • Norris C.
        • Merali S.
        • Graham M.M.
        • Koshal A.
        • Knudtson M.L.
        • Ghali W.A.
        Long-term outcome of isolated coronary artery bypass surgery in patients with severe left ventricular dysfunction.
        Circulation. 2004; 110: II13-II17
        • Nardi P.
        • Pellegrino A.
        • Scafuri A.
        • Colella D.
        • Bassano C.
        • Polisca P.
        • Chiariello L.
        Long-term outcome of coronary artery bypass grafting in patients with left ventricular dysfunction.
        Ann Thorac Surg. 2009; 87: 1401-1407
        • Kimura T.
        • Morimoto T.
        • Furukawa Y.
        • Nakagawa Y.
        • Kadota K.
        • Iwabuchi M.
        • Shizuta S.
        • Shiomi H.
        • Tada T.
        • Tazaki J.
        • Kato Y.
        • Hayano M.
        • Abe M.
        • Tamura T.
        • Shirotani M.
        • Miki S.
        • Matsuda M.
        • Takahashi M.
        • Ishii K.
        • Tanaka M.
        • Aoyama T.
        • Doi O.
        • Hattori R.
        • Tatami R.
        • Suwa S.
        • Takizawa A.
        • Takatsu Y.
        • Takahashi M.
        • Kato H.
        • Takeda T.
        • Lee J.-D.
        • Nohara R.
        • Ogawa H.
        • Tei C.
        • Horie M.
        • Kambara H.
        • Fujiwara H.
        • Mitsudo K.
        • Nobuyoshi M.
        • Kita T.
        Long-term safety and efficacy of sirolimus-eluting stents versus bare-metal stents in real world clinical practice in Japan.
        Cardiovasc Interven Ther. 2011; 26: 234-245
        • Shiomi H.
        • Morimoto T.
        • Hayano M.
        • Furukawa Y.
        • Nakagawa Y.
        • Tazaki J.
        • Imai M.
        • Yamaji K.
        • Tada T.
        • Natsuaki M.
        • Saijo S.
        • Funakoshi S.
        • Nagao K.
        • Hanazawa K.
        • Ehara N.
        • Kadota K.
        • Iwabuchi M.
        • Shizuta S.
        • Abe M.
        • Sakata R.
        • Okabayashi H.
        • Hanyu M.
        • Yamazaki F.
        • Shimamoto M.
        • Nishiwaki N.
        • Imoto Y.
        • Komiya T.
        • Horie M.
        • Fujiwara H.
        • Mitsudo K.
        • Nobuyoshi M.
        • Kita T.
        • Kimura T.
        Comparison of long-term outcome after percutaneous coronary intervention versus coronary artery bypass grafting in patients with unprotected left main coronary artery disease (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).
        Am J Cardiol. 2012; 110: 924-932
        • Teichholz L.E.
        • Kreulen T.
        • Herman M.V.
        • Gorlin R.
        Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy.
        Am J Cardiol. 1976; 37: 7-11
        • Schiller N.B.
        • Shah P.M.
        • Crawford M.
        • DeMaria A.
        • Devereux R.
        • Feigenbaum H.
        • Gutgesell H.
        • Reichek N.
        • Sahn D.
        • Schnittger I.
        • Silverman N.H.
        • Taijk A.J.
        Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms.
        J Am Soc Echocardiogr. 1989; 2: 358-367
        • Shiomi H.
        • Tamura T.
        • Niki S.
        • Tada T.
        • Tazaki J.
        • Toma M.
        • Ono K.
        • Shioi T.
        • Morimoto T.
        • Akao M.
        • Furukawa Y.
        • Nakagawa Y.
        • Kimura T.
        Inter- and intra-observer variability for assessment of the synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) score and association of the SYNTAX score with clinical outcome in patients undergoing unprotected left main stenting in the real world.
        Circ J. 2011; 75: 1130-1137
        • Serruys P.
        • Morice M.
        • Kappetein A.
        • Colombo A.
        • Holmes D.
        • Mack M.
        • Ståhle E.
        • Feldman T.
        • van den Brand M.
        • Bass E.
        • Van Dyck N.
        • Leadley K.
        • Dawkins K.
        • Mohr F.
        Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.
        N Engl J Med. 2009; 360: 961-972
        • Morice M.C.
        • Serruys P.W.
        • Kappetein A.P.
        • Feldman T.E.
        • Stahle E.
        • Colombo A.
        • Mack M.J.
        • Holmes D.R.
        • Torracca L.
        • van Es G.A.
        • Leadley K.
        • Dawkins K.D.
        • Mohr F.
        Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial.
        Circulation. 2010; 121: 2645-2653
        • Serruys P.W.
        • Unger F.
        • Sousa J.E.
        • Jatene A.
        • Bonnier H.J.R.M.
        • Schonberger J.P.A.M.
        • Buller N.
        • Bonser R.
        • van den Brand M.J.B.
        • van Herwerden L.A.
        • Morel M.A.M.
        • van Hout B.A.
        • Therapi AR
        Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease.
        N Engl J Med. 2001; 344: 1117-1124
        • Tazaki J.
        • Shiomi H.
        • Morimoto T.
        • Imai M.
        • Yamaji K.
        • Sakata R.
        • Okabayashi H.
        • Hanyu M.
        • Shimamoto M.
        • Nishiwaki N.
        • Komiya T.
        • Kimura T.
        Three-year outcome after percutaneous coronary intervention and coronary artery bypass grafting in patients with triple-vessel coronary artery disease: observations from the CREDO-Kyoto PCI/CABG registry cohort-2.
        EuroIntervention. 2013; 9: 437-445
      1. Marui A, Kimura T, Nishiwaki N, Komiya T, Hanyu M, Shiomi H, Tanaka S, Sakata R. Three-year outcomes after percutaneous coronary intervention and coronary artery bypass grafting in patients with heart failure: from the CREDO-Kyoto percutaneous coronary intervention/coronary artery bypass graft registry cohort-2. Eur J Cardiothorac Surg, in press.

        • Hannan E.L.
        • Wu C.
        • Walford G.
        • Culliford A.T.
        • Gold J.P.
        • Smith C.R.
        • Higgins R.S.
        • Carlson R.E.
        • Jones R.H.
        Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease.
        N Engl J Med. 2008; 358: 331-341
        • Hlatky M.A.
        • Boothroyd D.B.
        • Baker L.
        • Kazi D.S.
        • Solomon M.D.
        • Chang T.I.
        • Shilane D.
        • Go A.S.
        Comparative effectiveness of multivessel coronary bypass surgery and multivessel percutaneous coronary intervention a cohort study.
        Ann Intern Med. 2013; 158: 727-735
        • Nagendran J.
        • Norris C.M.
        • Graham M.M.
        • Ross D.B.
        • Macarthur R.G.
        • Kieser T.M.
        • Maitland A.M.
        • Southern D.
        • Meyer S.R.
        Coronary revascularization for patients with severe left ventricular dysfunction.
        Ann Thorac Surg. 2013; 96: 2038-2044
        • Yang J.H.
        • Choi S.H.
        • Song Y.B.
        • Hahn J.Y.
        • Choi J.H.
        • Jeong D.S.
        • Sung K.
        • Kim W.S.
        • Lee Y.T.
        • Gwon H.C.
        Long-term outcomes of drug-eluting stent implantation versus coronary artery bypass grafting for patients with coronary artery disease and chronic left ventricular systolic dysfunction.
        Am J Cardiol. 2013; 112: 623-629
        • Hlatky M.
        • Boothroyd D.
        • Bravata D.
        • Boersma E.
        • Booth J.
        • Brooks M.
        • Carrié D.
        • Clayton T.
        • Danchin N.
        • Flather M.
        • Hamm C.
        • Hueb W.
        • Kähler J.
        • Kelsey S.
        • King S.
        • Kosinski A.
        • Lopes N.
        • McDonald K.
        • Rodriguez A.
        • Serruys P.
        • Sigwart U.
        • Stables R.
        • Owens D.
        • Pocock S.
        Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials.
        Lancet. 2009; 373: 1190-1197
        • Kunadian V.
        • Pugh A.
        • Zaman A.G.
        • Qiu W.
        Percutaneous coronary intervention among patients with left ventricular systolic dysfunction: a review and meta-analysis of 19 clinical studies.
        Coron Artery Dis. 2012; 23: 469-479
        • Mohr F.W.
        • Morice M.C.
        • Kappetein A.P.
        • Feldman T.E.
        • Stahle E.
        • Colombo A.
        • Mack M.J.
        • Holmes Jr., D.R.
        • Morel M.A.
        • Van Dyck N.
        • Houle V.M.
        • Dawkins K.D.
        • Serruys P.W.
        Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical syntax trial.
        Lancet. 2013; 381: 629-638
        • Deb S.
        • Wijeysundera H.C.
        • Ko D.T.
        • Tsubota H.
        • Hill S.
        • Fremes S.E.
        Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review.
        JAMA. 2013; 310: 2086-2095
        • Hillis L.D.
        • Smith P.K.
        • Anderson J.L.
        • Bittl J.A.
        • Bridges C.R.
        • Byrne J.G.
        • Cigarroa J.E.
        • Disesa V.J.
        • Hiratzka L.F.
        • Hutter Jr., A.M.
        • Jessen M.E.
        • Keeley E.C.
        • Lahey S.J.
        • Lange R.A.
        • London M.J.
        • Mack M.J.
        • Patel M.R.
        • Puskas J.D.
        • Sabik J.F.
        • Selnes O.
        • Shahian D.M.
        • Trost J.C.
        • Winniford M.D.
        2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2011; 124: e652-e735
        • Wijns W.
        • Kolh P.
        • Danchin N.
        • Di Mario C.
        • Falk V.
        • Folliguet T.
        • Garg S.
        • Huber K.
        • James S.
        • Knuuti J.
        • Lopez-Sendon J.
        • Marco J.
        • Menicanti L.
        • Ostojic M.
        • Piepoli M.F.
        • Pirlet C.
        • Pomar J.L.
        • Reifart N.
        • Ribichini F.L.
        • Schalij M.J.
        • Sergeant P.
        • Serruys P.W.
        • Silber S.
        • Sousa Uva M.
        • Taggart D.
        • Vahanian A.
        • Auricchio A.
        • Bax J.
        • Ceconi C.
        • Dean V.
        • Filippatos G.
        • Funck-Brentano C.
        • Hobbs R.
        • Kearney P.
        • McDonagh T.
        • Popescu B.A.
        • Reiner Z.
        • Sechtem U.
        • Sirnes P.A.
        • Tendera M.
        • Vardas P.E.
        • Widimsky P.
        • Alfieri O.
        • Dunning J.
        • Elia S.
        • Kappetein P.
        • Lockowandt U.
        • Sarris G.
        • Vouhe P.
        • von Segesser L.
        • Agewall S.
        • Aladashvili A.
        • Alexopoulos D.
        • Antunes M.J.
        • Atalar E.
        • Brutel de la Riviere A.
        • Doganov A.
        • Eha J.
        • Fajadet J.
        • Ferreira R.
        • Garot J.
        • Halcox J.
        • Hasin Y.
        • Janssens S.
        • Kervinen K.
        • Laufer G.
        • Legrand V.
        • Nashef S.A.
        • Neumann F.J.
        • Niemela K.
        • Nihoyannopoulos P.
        • Noc M.
        • Piek J.J.
        • Pirk J.
        • Rozenman Y.
        • Sabate M.
        • Starc R.
        • Thielmann M.
        • Wheatley D.J.
        • Windecker S.
        • Zembala M.
        Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2010; 31: 2501-2555
        • Fanari Z.
        • A Weiss S.
        • Weintraub W.S.
        Comparative effectiveness of revascularization strategies in stable ischemic heart disease: current perspective and literature review.
        Expert Rev Cardiovasc Ther. 2013; 11: 1321-1336
        • Magnuson E.A.
        • Farkouh M.E.
        • Fuster V.
        • Wang K.
        • Vilain K.
        • Li H.
        • Appelwick J.
        • Muratov V.
        • Sleeper L.A.
        • Boineau R.
        • Abdallah M.
        • Cohen D.J.
        Cost-effectiveness of percutaneous coronary intervention with drug eluting stents versus bypass surgery for patients with diabetes mellitus and multivessel coronary artery disease: results from the FREEDOM trial.
        Circulation. 2013; 127: 820-831