Multivessel disease associated to ventricular function deterioration is challenging in terms of risk, when choosing a revascularization strategy.
According to this recent analysis of the SCAAR registry published in the European Heart Journal, long term followup seems to justify taking a higher risk initially, higher risk being myocardial revascularization surgery (CABG).
The study looked at all cause death in patients receiving CABG vs PCI presenting cardiac failure due to ventricular function deterioration and multivessel disease (>50% angiographic lesion in at least 2 vessels or in left main).
Propensity score was used to compare populations, which resulted in a total of 2509 patients; 35.8% presented diabetes and a similar percentage had prior MI history. Mean age was 68.1 ± 9.4 years with nearly half the population over 70, and most had lesions in 3 vessels or in the left main.
Patients were initially treated with PCI (56.2%) and surgery (43.8% of the population).
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After mean followup of four years (some reached 10) mortality resulted lower in the surgery group (OR 0.62; CI 95% 0.41 to 0.96; p=0.031). However, this increased linearly in centers where PCI was the preferred revascularization strategy.
Conclusion
In the long term, patients with ischemic heart failure will benefit from the surgical revascularization strategy.
Original Title: 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).
Reference: Sebastian Völz et al. European Heart Journal (2021) 42, 2657–2664 doi:10.1093/eurheartj/ehab273.
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