Utility of coronary revascularization in patients with ischemic left ventricular dysfunction

医学 血运重建 心脏病学 内科学 经皮冠状动脉介入治疗 传统PCI 心肌梗塞 比例危险模型
作者
Mohammed Al‐Sadawi,Michael Tao,Simrat Dhaliwal,Archanna Radakrishnan,Yang Liu,Chad Gier,Ravi Masson,Tahmid Rahman,Edlira Tam,Noelle Mann
出处
期刊:Cardiovascular Revascularization Medicine [Elsevier]
卷期号:65: 88-97
标识
DOI:10.1016/j.carrev.2024.02.021
摘要

Revascularization in patients with left ventricular (LV) dysfunction has been a subject of ongoing uncertainty and conflicting results. This is further complicated by factors including viability, severity of LV dysfunction, and method of revascularization using percutaneous coronary intervention (PCI) versus coronary-artery bypass grafting (CABG). The purpose of this meta-analysis is to evaluate the association of coronary revascularization with outcomes in patients with ischemic LV dysfunction. A literature search was conducted for studies reporting on cardiovascular outcomes after revascularization compared to optimal medical therapy (OMT) in patients with ischemic LV dysfunction. A total of 23 studies with 10,110 participants met inclusion criteria. Revascularization was significantly associated with lower all-cause mortality and CV mortality compared to OMT. The association was statistically significant regardless of severity of LV dysfunction or method of revascularization. Subgroup analysis demonstrated that revascularization was significantly associated with lower all-cause and CV mortality compared to OMT for patients with viable myocardium and mixed cohorts with variable viability, but not patients without viable myocardium. Revascularization was not associated with a significant difference in risk of heart failure (HF) hospitalization or acute myocardial infarction (AMI) compared to OMT. Revascularization in patients with ischemic LV dysfunction is associated with lower risk of all-cause and CV mortality independent of severity of LV dysfunction or method of revascularization. Revascularization is not associated with lower risk of mortality in patients without evidence of viable myocardium and is not associated with lower risk of AMI or HF hospitalization.

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