Comparison of coronary artery bypass grafting and percutaneous coronary intervention in patients with heart failure with reduced ejection fraction and multivessel coronary artery disease

// Michal Hawranek 1 , Michal O. Zembala 2 , Mariusz Gasior 1 , Tomasz Hrapkowicz 2 , Łukasz Pyka 1 , Daniel Cieśla 3 and Marian Zembala 2 1 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease, Zabrze, Poland 2 Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland 3 Department of Science, Biostatistics and New Technologies, Silesian Centre for Heart Disease, Zabrze, Poland Correspondence to: Michal Hawranek, email: mhawranek@poczta.fm Keywords: chronic heart failure; ischemic cardiomyopathy; percutaneous coronary interventions; coronary artery bypass grafting; revascularization Received: October 16, 2017      Accepted: March 01, 2018      Published: April 20, 2018 ABSTRACT Aims: To compare coronary artery bypass grafting (CABG) with percutaneous coronary interventions (PCI) in patients with heart failure with reduced ejection fraction (HFrEF) and multivessel coronary artery disease. Methods: 1213 patients were selected from institutional databases, 761 and 452 in CABG and PCI group respectively. Only the subjects with left ventricle ejection fraction ≤ 35% and multivessel coronary artery disease were included to the study. The primary outcome measure was long-term all-cause death, the secondary outcomes were recurrent myocardial infarction, urgent repeat revascularization and stroke. Propensity Score-Based Adjusted Survival Curves were used for revascularization methods comparison. Results: Survival rates were similar in both groups (HR, 0.91; 95% CI, 0.65-1.28; p=0.59). Recurrent myocardial infarction was observed significantly less often in the CABG group (HR, 0.44; 95% CI, 0.26-0.74; p=0.002). Repeat urgent revascularization was less frequent in the CABG group (HR, 0.50; 95% CI, 0.30-0.84; p=0.008). The rate of stroke did not differ between the groups (HR, 1.17; 95% CI, 0.62-2.22; p=0.62). Conclusions: In patients with HFrEF and multivessel CAD revascularization both with CABG and PCI resulted in similar survival rates. PCI is associated with increased risk of recurrent MI and urgent repeat revascularization, whereas the risk of stroke is similar in both methods.