1. Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients With Reduced Ejection Fraction and Coronary Artery Disease
- Author
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Michalina Kołodziejczak, Georg Wolff, Giuseppe Calveri, Marco Matteo Ciccone, Annapaola Zito, Dimitrios Dimitroulis, Michele Occhipinti, Fiorella Devito, Eliano Pio Navarese, Christian Jung, Pietro Scicchitano, Battistina Castiglioni, Felicita Andreotti, Francesco Maisano, Stefano De Servi, University of Zurich, and Navarese, Eliano P
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Ischemia ,heart failure ,610 Medicine & health ,meta ,030204 cardiovascular system & hematology ,Revascularization ,Risk Assessment ,Article ,2705 Cardiology and Cardiovascular Medicine ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Survival analysis ,Aged ,Ejection fraction ,business.industry ,Percutaneous coronary intervention ,Stroke Volume ,Stroke volume ,Middle Aged ,medicine.disease ,Survival Analysis ,10020 Clinic for Cardiac Surgery ,coronary artery bypass ,myocardial infarction ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,coronary artery disease ,Analysis - Abstract
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 P P 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.
- Published
- 2017
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