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Introduction and Objectives: There are 2 options to achieve revascularization in ischemic cardiomyopathy: percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). While the benefits of PCI for ischemic cardiomyopathy are unclear, achieving complete revascularization with PCI could improve outcomes comparable to CABG., Methods: A total of 1496 patients with left ventricular ejection fraction (LVEF) <50% and multivessel disease who underwent either PCI or CABG were selected from a single-center cohort registry. They were divided into the PCI with complete revascularization (n=188), the PCI with incomplete revascularization (n=263), and the CABG group (n=1045), and then compared. The primary outcome was a 5-year composite of cardiac death or myocardial infarction., Results: A total of 1496 patients treated for ischemic cardiomyopathy was stratified into CABG (n=1045) and PCI (n=451) groups, the latter subdivided into complete (n=188) or incomplete revascularization (n=263). PCI showed a higher incidence of the primary outcome compared with CABG (PCI vs CABG, 27.8% vs 22.2%, adjusted HR, 1.35; 95%CI, 1.05-1.73, P=.019). However, PCI with complete revascularization and CABG had similar incidences of the primary outcome (20.5% vs 22.2%, adjusted HR, 1.07; 95%CI, 0.73-1.57; P=.718)., Conclusions: CABG is associated with more favorable clinical outcomes than PCI in patients with ischemic cardiomyopathy. However, achieving complete revascularization with PCI could improve outcomes comparable to CABG., Competing Interests: CONFLICTS OF INTEREST There are no conflicts of interest related to this article., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Although visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat., Methods: A total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm 2 )/height 2 (m 2 ) at the L3 level. The primary outcome was all-cause mortality during follow-up., Results: Patients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%CI, 0.91-0.97; P<.001). Patients in the low VFAI group had a higher incidence of long-term mortality than those in the intermediate and high VFAI groups (T1 36.1%, T2 27.2%, and T3 29.1%; T1 vs T2; adjusted HR, 1.36; 95%CI, 1.15-1.61; P<.001; T1 vs T3; adjusted HR, 1.37; 95%CI, 1.16-1.62; P<.001). Similar results were obtained after inverse probability treatment-weighting analysis., Conclusions: Low visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)