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著者: Georg Wolff, Dimitrios Dimitroulis, Felicita Andreotti, Michalina Kołodziejczak, Christian Jung, Pietro Scicchitano, Fiorella Devito, Annapaola Zito, Michele Occhipinti, Battistina Castiglioni, Giuseppe Calveri, Francesco Maisano, Marco M Ciccone, Stefano De Servi, Eliano P Navarese
雑誌名: Circ Heart Fail. 2017 Jan;10(1). doi: 10.1161/CIRCHEARTFAILURE.116.003255.
Abstract/Text
BACKGROUND: Heart failure with reduced ejection fraction caused by ischemic heart disease is associated with increased morbidity and mortality. It remains unclear whether revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) carries benefits or risks in this group of stable patients compared with medical treatment.
METHODS AND RESULTS: We performed a meta-analysis of available studies comparing different methods of revascularization (PCI or CABG) against each other or medical treatment in patients with coronary artery disease and left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality; myocardial infarction, revascularization, and stroke were also analyzed. Twenty-one studies involving a total of 16 191 patients were included. Compared with medical treatment, there was a significant mortality reduction with CABG (hazard ratio, 0.66; 95% confidence interval, 0.61-0.72; P<0.001) and PCI (hazard ratio, 0.73; 95% confidence interval, 0.62-0.85; P<0.001). When compared with PCI, CABG still showed a survival benefit (hazard ratio, 0.82; 95% confidence interval, 0.75-0.90; P<0.001).
CONCLUSIONS: The present meta-analysis indicates that revascularization strategies are superior to medical treatment in improving survival in patients with ischemic heart disease and reduced ejection fraction. Between the 2 revascularization strategies, CABG seems more favorable compared with PCI in this particular clinical setting.
© 2017 American Heart Association, Inc.
PMID 28087687 Circ Heart Fail. 2017 Jan;10(1). doi: 10.1161/CIRCHEARTFAILURE.116.003255.
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