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Heart failure and cardiomyopathies
Original research
Coronary artery bypass graft versus percutaneous coronary intervention in acute heart failure
  1. Sang Eun Lee1,
  2. Hae-Young Lee2,
  3. Hyun-Jai Cho2,
  4. Won-Seok Choe2,
  5. Hokon Kim2,
  6. Jin Oh Choi3,
  7. Eun-Seok Jeon3,
  8. Min-Seok Kim1,
  9. Kyung-Kuk Hwang4,
  10. Shung Chull Chae5,
  11. Sang Hong Baek6,
  12. Seok-Min Kang7,
  13. Dong-Ju Choi8,
  14. Byung-Su Yoo9,
  15. Kye Hun Kim10,
  16. Myeong-Chan Cho4,
  17. Jae-Joong Kim1,
  18. Byung-Hee Oh2
  1. 1 Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  2. 2 Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  3. 3 Sungkyunkwan University College of Medicine, Seoul, Korea
  4. 4 Chungbuk National University College of Medicine, Cheongju, Korea
  5. 5 Kyungpook National University College of Medicine, Daegu, Korea
  6. 6 The Catholic University of Korea, Seoul, Korea
  7. 7 Yonsei University College of Medicine, Seoul, Korea
  8. 8 Seoul National University Bundang Hospital, Seongnam, Korea
  9. 9 Yonsei University Wonju College of Medicine, Wonju, Korea
  10. 10 Heart Research Center of Chonnam National University, Gwangju, Korea
  1. Correspondence to Dr Hae-Young Lee, Department of Internal Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul 110-744, Korea; hylee612{at}snu.ac.kr

Abstract

Objective Myocardial ischaemia is a leading cause of acute heart failure (AHF). However, optimal revascularisation strategies in AHF are unclear. We aimed to compare two revascularisation strategies, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), in patients with AHF.

Methods Among 5625 consecutive patients enrolled prospectively in the Korean Acute Heart Failure registry from March 2011 to February 2014, 717 patients who received CABG or PCI during the index hospitalisation for AHF were included in this analysis. We compared adverse outcomes (death, rehospitalisation for HF aggravation or cardiovascular causes, ischaemic stroke and a composite outcome of death and rehospitalisation for HF aggravation or cardiovascular causes) with the use of propensity score matching.

Results For the propensity score-matched cohort with 190 patients, CABG had a lower risk of all-cause mortality than PCI (83 vs 147 deaths per 1000 patient-years; HR 0.57, 95% CI 0.34 to 0.96, p=0.033) during the median follow-up of 4 years. There was also a trend towards lower rates of rehospitalisation due to cardiovascular events or HF aggravation. Subgroup analysis revealed that the adverse outcomes were significantly lower in the CABG group than in PCI group, especially in patients with old age, three-vessel diseases, significant proximal left anterior descending artery disease and those without left main vessel disease or chronic total occlusion.

Conclusions Compared with PCI, CABG is associated with significant lower all-cause mortality in patients with AHF. Further studies should evaluate proper revascularisation strategies in AHF.

Clinical trial registration NCT01389843; Results.

  • heart failure
  • percutaneous coronary intervention
  • coronary artery disease surgery

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/heartjnl-2018-313242

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    Footnotes

    • Contributors Conception and design: SEL, H-YL, E-SJ, SHB, M-CC, D-JC, J-JK, B-HO; data acquisition: SEL, H-JC, W-SC, HK, JOC, M-SK, B-SY; data analysis and interpretation: SEL, H-YL; statistical analysis: SEL, H-YL; drafting and finalising the article: SEL, HYL, BHO; critical revision of the article for important intellectual content: E-SJ, K-KH, SCC, SHB, S-MK, D-JC, B-SY, K-HK, M-CC, J-JK, B-HO.

    • Funding This work was supported by grants from Research of Korea Centers for Disease Control and Prevention (2010-E63003-00, 2011-E63002-00, 2012-E63005-00, 2013-E63003-00, 2013-E63003-01, 2013-E63003-02, 2016-ER6303-00 and 2016-ER6303-01).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study protocol was approved by the ethics committee/institutional review board (IRB) of each hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.