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Lee G, Malik A, Vervoort D, Tam DY, Marquis-Gravel G, Redfors B, Gaudino M, Fremes SE. Revascularization in Left Ventricular Systolic Dysfunction: A Meta-Analysis of Kaplan-Meier Reconstructed Individual Patient Data. Can J Cardiol 2024:S0828-282X(24)00414-8. [PMID: 38823634 DOI: 10.1016/j.cjca.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Coronary artery disease is a common etiology of ischemic left ventricular systolic dysfunction (LVSD), for which the optimal revascularization strategy remains unclear. We aimed to determine whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) results in greater survival advantage in patients with LVSD. METHODS A study-level (SLMA) and reconstructed individual patient data meta-analysis (rIPDMA) from Kaplan-Meier (KM) survival curves were performed. A systematic search of MEDLINE, EMBASE, and Cochrane was conducted for observational and randomized studies published after 2010 that compared PCI to CABG in patients with left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality at longest follow-up. The secondary outcomes were myocardial infarction (MI), stroke, repeat revascularization, cardiovascular mortality, and major adverse cardiovascular and cerebrovascular events (MACCE) at longest follow-up. RESULTS Fourteen studies (11 observational, three randomized, 13,063 patients) were eligible for SLMA. Seven contained digitizable KM curves from which individual patient data could be reconstructed. Study-level analysis found PCI associated with increased all-cause mortality (Hazard Ratio 1.41 [95% Confidence Interval 1.18-1.69]), MI (2.10 [1.62-2.72]), repeat revascularization (2.39 [1.37-4.17]) and MACCE (1.58 [1.23-2.03]), without significant differences in stroke (0.86 [0.39-1.92]) or cardiovascular mortality (1.42 [0.78-2.59]). In the rIPDMA, PCI resulted in increased all-cause mortality (1.57 [1.34-1.87]) and repeat revascularization (3.63 [3.12-4.21]) but overall lower risk of stroke (0.62 [0.39-0.99]) due to fewer events during initial follow-up. CONCLUSIONS In patients with ischemic LVSD, PCI was associated with higher risk of all-cause mortality and repeat revascularization than CABG but lower risk of short-term stroke.
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Affiliation(s)
- Grace Lee
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Malik
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Cedars-Sinai Medical Centre, Los Angeles, California
| | | | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, United States
| | - Stephen E Fremes
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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2
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Pavía-López AA, Magaña-Serrano JA, Cigarroa-López JA, Chávez-Mendoza A, Mayorga-Butrón JL, Araiza-Garaygordobil D, Ivey-Miranda JB, Méndez-Machado GF, González-Godínez H, Aguilera-Mora LF, Jordán-Ríos A, Olmos-Domínguez L, Olalde-Román MJ, Miranda-Malpica EM, Vázquez-Ortiz Z, Rayo-Chávez J, Mendoza AA, Márquez-Murillo MF, Chávez-Leal SA, Gabriel AÁS, Silva-García MA, Pacheco-Bouthiller AD, Aldrete-Velazco JA, Guizar-Sánchez CA, Gaxiola-López E, Guerra-López A, Figueiras-Graillet L, Sánchez-Miranda G, Mendoza-Zavala GH, Aceves-García M, Chávez-Negrete A, Arroyo-Hernández M, Montaño-Velázquez BB, Romero-Moreno LF, Baquero-Hoyos MM, Velasco-Hidalgo L, Rodríguez-Lozano AL, Aguilar-Gómez NE, Rodríguez-Vega M, Cossío-Aranda JE. Clinical practice guidelines for diagnostic and treatment of the chronic heart failure. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:1-74. [PMID: 38648647 PMCID: PMC11160508 DOI: 10.24875/acm.m24000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 04/25/2024] Open
Abstract
Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.
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Affiliation(s)
- Abel A. Pavía-López
- Coordinador de las Guías Mexicanas de Práctica Clínica de la Sociedad Mexicana de Cardiología, Centro Médico ABC, Ciudad de México, México
| | - José A. Magaña-Serrano
- Jefe de la División de Insuficiencia Cardiaca y Trasplante, Hospital Asociación Mexicana de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
- Presidente de la Asociación Mexicana de Insuficiencia Cardiaca, Ciudad de México, México
| | - José A. Cigarroa-López
- Jefe de la Clínica de Insuficiencia Cardiaca y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Adolfo Chávez-Mendoza
- Jefe de la Clínica de Insuficiencia Cardiaca Hospital de Día, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - José L. Mayorga-Butrón
- Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Ibero American Agency for Development & Assessment of Health Technologies
| | - Diego Araiza-Garaygordobil
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Juan B. Ivey-Miranda
- Adscrito a la Clínica de Insuficiencia Cardiaca Avanzada y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Gustavo F. Méndez-Machado
- Cardiólogo Especialista en Insuficiencia Cardiaca, Imperial College, Londres, Reino Unido
- Unidad de Investigación Clínica Hospital Ángeles Xalapa, Veracruz, México
| | | | - Luisa F. Aguilera-Mora
- Directora de la Clínica de Insuficiencia Cardiaca, Instituto Cardiovascular de Mínima Invasión, Hospital Puerta de Hierro, Zapopan, Jalisco, México
| | - Antonio Jordán-Ríos
- Coordinador Digital, Sociedad Mexicana de Cardiología A.C., México
- Cardiólogo Clínico, Ecocardiografía Adultos, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Luis Olmos-Domínguez
- Cardiólogo Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Marcos J. Olalde-Román
- Cardiólogo Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | | | | | - Jorge Rayo-Chávez
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Alexandra A. Mendoza
- Cardióloga Especialista en Medicina Crítica, Centro Médico ABC Observatorio, Ciudad de México, México
- Jefa de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Manlio F. Márquez-Murillo
- Cardiólogo Especialista en Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Sergio A. Chávez-Leal
- Clínica de Insuficiencia Cardiaca, SIMNSA Health Care, Tijuana, Baja California, México
| | - Amada Álvarez-San Gabriel
- Coordinadora del Programa de Insuficiencia Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | | | - Alex D. Pacheco-Bouthiller
- Director de la Clínica de Arritmias y Estimulación Cardiaca, Instituto Cardiovascular de Mínima Invasión, Hospital Puerta de Hierro, Zapopan, Jalisco, México
| | | | - Carlos A. Guizar-Sánchez
- Coordinador del Programa de Insuficiencia Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Hospital Central Sur, PEMEX, Ciudad de México, México
| | | | | | | | | | - Genaro H. Mendoza-Zavala
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Moisés Aceves-García
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Marisol Arroyo-Hernández
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Servicio de Neumología, Instituto Nacional de Cancerología, Tlapan, México
| | - Bertha B. Montaño-Velázquez
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Hospital de Especialidades, Centro Médico Nacional La Raza, Ciudad de México, México
| | - Luis F. Romero-Moreno
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Médico Adscrito a la Fundación Hospital de la Misericordia, Bogotá, Colombia
| | - María M. Baquero-Hoyos
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Liliana Velasco-Hidalgo
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Ana L. Rodríguez-Lozano
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Nancy E. Aguilar-Gómez
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Mario Rodríguez-Vega
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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Park H, Kang DY, Ahn JM, Yang DH, Koo HJ, Kang JW, Lee PH, Lee SE, Kim MS, Kang SJ, Park DW, Lee SW, Kim YH, Lee CW, Kim HJ, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JJ, Park SW, Park SJ. Myocardial Scar and Revascularization on Mortality in Ischemic Cardiomyopathy (from the Late Gadolinium Enhancement Cardiac Magnetic Resonance Study). Am J Cardiol 2023; 192:212-220. [PMID: 36848690 DOI: 10.1016/j.amjcard.2023.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/27/2022] [Accepted: 01/13/2023] [Indexed: 02/27/2023]
Abstract
Myocardial viability test to guide revascularization remains uncertain in patients with ischemic cardiomyopathy. We evaluated the different impacts of revascularization on cardiac mortality according to the extent of myocardial scar assessed by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) in patients with ischemic cardiomyopathy. A total of 404 consecutive patients with significant coronary artery disease and an ejection fraction ≤35% were assessed by LGE-CMR before revascularization. Of them, 306 patients underwent revascularization and 98 patients received medical treatment alone. The primary outcome was cardiac death. During a median follow-up of 6.3 years, cardiac death occurred in 158 patients (39.1%). Revascularization was associated with a significantly lower risk of cardiac death than medical treatment alone in the overall population (adjusted hazard ratio [aHR] 0.29, 95% confidence interval (CI) 0.19 to 0.45, p <0.001). There was a significant interaction between the number of segments with >75% transmural LGE and revascularization on the risk of cardiac death (p = 0.037 for interaction). In patients with limited myocardial scar (<6 segments with >75% transmural LGE, n = 354), revascularization had a significantly lower risk of cardiac death than medical treatment alone (aHR 0.24, 95% CI 0.15 to 0.37, p <0.001); in patients with extensive myocardial scar (≥6 segments with >75% transmural LGE, n = 50), there was no significant difference between revascularization and medical treatment alone regarding the risk of cardiac death (aHR 1.33, 95% CI 0.46 to 3.80, p = 0.60). In conclusion, the assessment of myocardial scar by LGE-CMR may be helpful in the decision-making process for revascularization in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Hanbit Park
- Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Republic of Korea
| | - Do-Yoon Kang
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Ahn
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil Hyung Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Eun Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Seok Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Jin Kang
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Whan Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Hak Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol Whan Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Jin Kim
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Kim
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Ho Jung
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk Jung Choo
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol-Hyun Chung
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Won Lee
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Joong Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Wook Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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4
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Daoulah A, Naser MJ, Hersi AS, Alshehri M, Garni TA, Abuelatta R, Yousif N, Almahmeed W, Alasmari A, Aljohar A, Alzahrani B, Abumelha BK, Ghani MA, Amin H, Hashmani S, Hiremath N, Kazim HM, Refaat W, Selim E, Jamjoom A, El-Sayed O, Al-Faifi SM, Feteih MN, Dahdouh Z, Aithal J, Ibrahim AM, Elganady A, Qutub MA, Alama MN, Abohasan A, Hassan T, Balghith M, Hussien AF, Abdulhabeeb IAM, Ahmad O, Ramadan M, Alqahtani AH, Alshahrani SS, Qenawi W, Shawky A, Ghonim AA, Elmahrouk A, Alhamid S, Maghrabi M, Haddara MM, Iskandar M, Shawky AM, Hurley WT, Elmahrouk Y, Ahmed WA, Lotfi A. Impact of left ventricular ejection fraction on outcomes after left main revascularization: g-LM Registry. J Cardiovasc Med (Hagerstown) 2023; 24:23-35. [PMID: 36219153 DOI: 10.2459/jcm.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS The impact of left ventricular dysfunction on clinical outcomes following revascularization is not well established in patients with unprotected left main coronary artery disease (ULMCA). In this study, we evaluated the impact of left ventricular ejection fraction (LVEF) on clinical outcomes of patients with ULMCA requiring revascularization with percutaneous coronary intervention (PCI) compared with coronary artery bypass graft (CABG). METHODS The details of the design, methods, end points, and relevant definitions are outlined in the Gulf Left Main Registry: a retrospective, observational study conducted between January 2015 and December 2019 across 14 centres in 3 Gulf countries. In this study, the data on patients with ULMCA who underwent revascularization through PCI or CABG were stratified by LVEF into three main subgroups; low (l-LVEF <40%), mid-range (m-LVEF 40-49%), and preserved (p-LVEF ≥50%). Primary outcomes were hospital major adverse cardiovascular and cerebrovascular events (MACCE) and mortality and follow-up MACCE and mortality. RESULTS A total of 2137 patients were included; 1221 underwent PCI and 916 had CABG. During hospitalization, MACCE was significantly higher in patients with l-LVEF [(10.10%), P = 0.005] and m-LVEF [(10.80%), P = 0.009], whereas total mortality was higher in patients with m-LVEF [(7.40%), P = 0.009] and p-LVEF [(7.10%), P = 0.045] who underwent CABG. There was no mortality difference between groups in patients with l-LVEF. At a median follow-up of 15 months, there was no difference in MACCE and total mortality between patients who underwent CABG or PCI with p-LVEF and m-LVEF. CONCLUSION CABG was associated with higher in-hospital events. Hospital mortality in patients with l-LVEF was comparable between CABG and PCI. At 15 months' follow-up, PCI could have an advantage in decreasing MACCE in patients with l-LVEF.
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Maryam Jameel Naser
- Department of Internal Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Springfield, Massachusetts, USA
| | - Ahmad S Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait
| | - Turki Al Garni
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh
| | - Reda Abuelatta
- Department of Cardiology, Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | - Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, UAE
| | - Abdulaziz Alasmari
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Alwaleed Aljohar
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh
| | - Badr Alzahrani
- Department of Cardiology, Prince Sultan Cardiac Center, Riyadh
| | - Bader K Abumelha
- Department of Family Medicine, King Abdulaziz Medical City, National Guard Hospital, Riyadh
| | - Mohamed Ajaz Ghani
- Department of Cardiology, Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
| | | | | | | | - Wael Refaat
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa
| | - Ehab Selim
- Department of Cardiology, Alhada Armed Forces Hospital, Taif
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Osama El-Sayed
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Salem M Al-Faifi
- Department of Medicine, King Faisal Specialist Hospital & Research Center
| | - Maun N Feteih
- Department of Medicine, King Faisal Specialist Hospital & Research Center
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jairam Aithal
- Department of Cardiology, Yas Clinic, Khalifa City A, Abu Dhabi, UAE
| | | | | | - Mohammed A Qutub
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah
| | - Mohamed N Alama
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah
| | | | - Taher Hassan
- Department of Cardiology, Bugshan General Hospital, Jeddah
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh
| | | | | | - Osama Ahmad
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa
| | | | - Saif S Alshahrani
- Department of Emergency Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait
| | - Ahmed Shawky
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait
| | - Ahmed A Ghonim
- Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.,Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Sameer Alhamid
- Department of Emergency Medicine, King Fahad Medical City
| | | | - Mamdouh M Haddara
- Department of Anesthesia, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mina Iskandar
- Department of Internal Medicine-Pediatrics, University of Massachusetts Chan Medical School - Baystate, Springfield, Springfield, Massachusetts
| | - Abeer M Shawky
- Department of Cardiology, Dr Erfan and Bagedo General Hospital
| | - William T Hurley
- Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Waleed A Ahmed
- Department of Internal Medicine, Security Forces Hospital, Mecca, Kingdom of Saudi Arabia
| | - Amir Lotfi
- Division of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Springfield, Massachusetts, USA
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5
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The Impact of Complete Revascularization in Symptomatic Severe Left Ventricular Dysfunction between Coronary Artery Bypass Graft and Percutaneous Coronary Intervention. Cardiol Res Pract 2023; 2023:9226722. [PMID: 36896424 PMCID: PMC9991473 DOI: 10.1155/2023/9226722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023] Open
Abstract
Objective The study aimed to compare the clinical outcomes between the patients receiving coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the patients with symptomatic severe left ventricular (LV) dysfunction and coronary artery disease (CAD). Methods Between February 2007 and February 2020, a total of 745 patients who received coronary artery angiography for reduced LV ejection fraction (LVEF) < 40% and symptomatic New York Heart Association (NYHA) functional class ≥ 3 were recruited. The patients (N = 236) who were diagnosed with dilated cardiomyopathy or valvular heart disease without coronary artery stenosis, those with prior history of CABG or valvular surgery (N = 59), those who presented ST-segment elevated myocardial infarction (STEMI), those with a CAD and SYNTAX score of ≦ 22 (N = 175), those who received emergent CABG for coronary perforation (N = 3), and those who had NYHA class ≦ 2 (N = 65) were excluded. Finally, 116 patients with reduced LVEF and those who had a SYNTAX score >22, who received CABG (N = 47) and PCI (N = 69), were recruited for this study. Results There was no significant difference in the incidence values of in-hospital course and those of in-hospital mortality, acute kidney injury, and postprocedural hemodialysis. There was no significant difference in the 1-yearfollow-up of recurrent MI, revascularization, or stroke between the groups. The 1-year heart failure (HF) hospitalization rate was significantly lower in the CABG group than in all patients of the PCI group (13.2% vs. 33.3%; p = 0.035); however, there was no significant difference in the same variable between the CABG group and the complete revascularization subgroup (13.2% vs. 28.2%; p = 0.160). The revascularization index (RI) was significantly higher in the CABG group than in all patients of the PCI group or complete revascularization subgroup (0.93 ± 0.12 vs. 0.71 ± 0.25; p < 0.001) and (0.93 ± 0.12 vs. 0.86 ± 0.13; p = 0.019). The 3-year HF hospitalization rate was significantly lower in the CABG group than in all patients of the PCI group (16.2% vs. 42.2%; p = 0.008); however, there was no difference in the same variable between the CABG group and the complete revascularization subgroup (16.2% vs. 35.1%; p = 0.109). Conclusions In patients with symptomatic (NYHA class ≥ 3) severe LV dysfunction and CAD, CABG brought less HF admission when compared to patients in the PCI group, but this did not differ when compared to the complete revascularization subgroup. Therefore, an extensive revascularization, achieved by CABG or PCI, is associated with a lower HF hospitalization rate during the 3-yearfollow-up period in such populations.
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Bianchi G, Zancanaro E, Margaryan R, Concistré G, Varone E, Simeoni S, Solinas M. Outcomes of Emergent Isolated Coronary Bypass Grafting in Heart Failure Patients. Life (Basel) 2022; 12:life12122124. [PMID: 36556489 PMCID: PMC9783056 DOI: 10.3390/life12122124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Patients with previously diagnosed HF are at greater risk for subsequent morbidity and mortality when hospitalized for an Acute Myocardial Infarction (AMI). The purpose of our study was to describe the time trend of the incidence of emergent CABG in patients with and without HF, the clinical characteristics, outcomes, and the risk factors for mortality of surgical revascularization in the short and medium term. This was a single-center retrospective observational study of patients who underwent isolated emergency CABG from January 2009 to January 2020. A propensity-score matching analysis yielded two comparable groups (n = 430) of patients without (n = 215) and with (n = 215) heart failure. In-hospital mortality did not differ in the two groups (2.8%; p > 0.9); the patients with heart failure presented more frequently with cardiogenic shock, and there was an association with mortality and mechanical circulatory support (OR 16.7−95% CI 3.31−140; p = 0.002) and postoperative acute renal failure (OR 15.9−95% CI 0.66−203; p = 0.036). In the early- and mid-term, heart failure and NSTEMI were associated with mortality (HR 3.47−95% CI 1.15−10.5; p = 0.028), along with age (HR 1.28−95% CI 1.21−1.36; p < 0.001). Surgical revascularization offers an excellent solution for patients with acute coronary syndrome, leading to a good immediate prognosis even in those with chronic heart failure.
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Affiliation(s)
- Giacomo Bianchi
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
- Correspondence: ; Tel.: +39-3404680379
| | - Edoardo Zancanaro
- Department of Cardiac Surgery, Università Vita-Salute San Raffaele, Via Olgettina, 58, 20132 Milan, Italy
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Giovanni Concistré
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Egidio Varone
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Simone Simeoni
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
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Coronary Artery Bypass Graft Surgery Brings Better Benefits to Heart Failure Hospitalization for Patients with Severe Coronary Artery Disease and Reduced Ejection Fraction. Diagnostics (Basel) 2022; 12:diagnostics12092233. [PMID: 36140634 PMCID: PMC9497955 DOI: 10.3390/diagnostics12092233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: We compared the outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) for revascularization in patients with reduced ejection fraction (EF) and severe coronary artery disease (CAD). Methods: Between February 2006 and February 2020, a total of 797 patients received coronary angiograms due to left ventricular EF ≤ 40% at our hospital. After excluding diagnoses of dilated cardiomyopathy, valvular heart disease, prior CABG, acute ST-segment myocardial infarction, and CAD with low Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score (≤22), 181 patients with severe coronary artery disease (CAD) with SYNTAX score >22 underwent CABG or PCI for revascularization. Vascular characteristics as well as echocardiographic data were compared between CABG (n = 58) and PCI (n = 123) groups. Results: A younger age (62 ± 9.0 vs. 66 ± 12.1; p = 0.016), higher new EuroSCORE II (8.6 ± 7.3 vs. 3.2 ± 2.0; p < 0.001), and higher SYNTAX score (40.5 ± 9.8 vs. 35.4 ± 8.3; p < 0.001) were noted in the CABG group compared to those in the PCI group. The CABG group had a significantly higher cardiovascular mortality rate at 1-year (19.6% vs. 5.0%, p = 0.005) and 3-year (25.0% vs. 11.4%, p = 0.027) follow-ups but a lower incidence of heart failure (HF) hospitalization at 1-year (11.1% vs. 28.2%, p = 0.023) and 3-year (3.6% vs. 42.5%, p = 0.001) follow-ups compared to those of the PCI group. Conclusions: Compared with PCI, revascularization with CABG was related to a lower incidence of HF hospitalization but a worse survival outcome in patients with severe CAD and reduced EF. CABG-associated reduction in HF hospitalization was more notable when SYNTAX score ≥33.
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Chew DS, Cowper PA, Al-Khalidi H, Anstrom KJ, Daniels MR, Davidson-Ray L, Li Y, Michler RE, Panza JA, Piña IL, Rouleau JL, Velazquez EJ, Mark DB. Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Medicine in Ischemic Cardiomyopathy: The STICH Randomized Clinical Trial. Circulation 2022; 145:819-828. [PMID: 35044802 PMCID: PMC8959089 DOI: 10.1161/circulationaha.121.056276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The STICH Randomized Clinical Trial (Surgical Treatment for Ischemic Heart Failure) demonstrated that coronary artery bypass grafting (CABG) reduced all-cause mortality rates out to 10 years compared with medical therapy alone (MED) in patients with ischemic cardiomyopathy and reduced left ventricular function (ejection fraction ≤35%). We examined the economic implications of these results. METHODS We used a decision-analytic patient-level simulation model to estimate the lifetime costs and benefits of CABG and MED using patient-level resource use and clinical data collected in the STICH trial. Patient-level costs were calculated by applying externally derived US cost weights to resource use counts during trial follow-up. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio assessed from the US health care sector perspective. RESULTS For the CABG arm, we estimated 6.53 quality-adjusted life-years (95% CI, 5.70-7.53) and a lifetime cost of $140 059 (95% CI, $106 401 to $180 992). For the MED arm, the corresponding estimates were 5.52 (95% CI, 5.06-6.09) quality-adjusted life-years and $74 894 lifetime cost (95% CI, $58 372 to $93 541). The incremental cost-effectiveness ratio for CABG compared with MED was $63 989 per quality-adjusted life-year gained. At a societal willingness-to-pay threshold of $100 000 per quality-adjusted life-year gained, CABG was found to be economically favorable compared with MED in 87% of microsimulations. CONCLUSIONS In the STICH trial, in patients with ischemic cardiomyopathy and reduced left ventricular function, CABG was economically attractive relative to MED at current benchmarks for value in the United States. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT00023595.
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Affiliation(s)
- Derek S Chew
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC.,Department of Cardiac Sciences, Libin Cardiovascular Institute (D.S.C.), University of Calgary, Alberta, Canada.,O'Brien Institute for Public Health (D.S.C.), University of Calgary, Alberta, Canada
| | - Patricia A Cowper
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC
| | - Hussein Al-Khalidi
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC.,Department of Biostatistics and Bioinformatics (H.A., K.J.A.), Duke University, Durham, NC
| | - Kevin J Anstrom
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC.,Department of Biostatistics and Bioinformatics (H.A., K.J.A.), Duke University, Durham, NC
| | - Melanie R Daniels
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC
| | - Linda Davidson-Ray
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC
| | - Yanhong Li
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC
| | - Robert E Michler
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.)
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center, Westchester Medical Center Health Network, Valhalla, NY (J.A.P.)
| | - Ileana L Piña
- Department of Medicine, Wayne State University, Detroit, MI (I.L.P.)
| | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.)
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.J.V.)
| | - Daniel B Mark
- Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC.,Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (D.B.M.)
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