Author + information
- Lukasz Pyka1,
- Jaroslaw Gorol1,
- Mateusz Tajstra2,
- Cislak Aneta3,
- Piotr Desperak3,
- Marek Gierlotka4,
- Michal Hawranek4,
- Piotr Rozentryt1,
- Alicja Nowowiejska-Wiewiora5,
- Andrzej Lekston6,
- Marian Zembala4,
- Lech Polonski4 and
- Mariusz Gasior4
Heart failure (HF) is the major cause of death in cardiovascular disease, with coronary artery disease (CAD) remaining its most common cause. STICH trial has left us with many questions unanswered and most PCI-related trials exclude subjects with ejection fraction (EF) < 35%. Complete coronary revascularization is one of key concepts in management of ischemic HF.
We have retrospectively analyzed 1078 unselected patients with systolic HF (EF< 35%) hospitalized between 2009-2012. Among them we have selected a group of non-ACS pts scheduled for coronary angiography (n=495). 57 CABG-qualified subjects were excluded from analysis. Pts were divided into group A (complete revascularization, n=221) and group B (incomplete revascularization, n=217). Complete revascularization was assessed angiographically, defined according to current ESC guidelines (vessels >2mm). Patients were in 12-month follow-up for rehospitalisation, myocardial infarction and mortality.
Patient characteristics are presented in table 1. Patients in group A had higher prevalence or prior PCI (54,3 vs 38,2%, p=0,001), with no differences in prior CAGB (20,8 vs 22,1%, p=ns). The incidence of multi-vessel disease was significantly higher in group B (32,4 vs 68,1%, p< 0,01). There have been no significant differences in PCI strategy in both groups. In follow up 12-month mortality was significantly lower in pts with complete revascularization (10,4 vs 18,43%, p=0,01). The composite endpoint of death or MI was also significantly in favor of complete revascularization (11,7 vs 23,5%, p=0,01).
Our study shows, that in an unselected ischemic HF population complete revascularization has led to improved survival. If possible, complete revascularization in HF should be considered, and should be one of the factors determining the selection of revascularization method, with PCI emerging as a safe and viable option.
|Group A||Group B|
|Sex||177M vs 44F||168M vs 49F|
|Mean EF [%]||28,8±6,9||27,4±58|
|Atrial fibrillation [%, p=ns]||16,2||18,8|
|NYHA III & IV [%, p=ns]||29,8||32,7|
|Chronic kidney disease stage III-V [%, p=0,02]||32,3||42,4|
|Diabetes [%, p=0,04]||38,4||47,9|