Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

Aims To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of patients with heart failure due to ischaemic heart disease. Methods and results We analysed all-cause mortality following CABG or PCI in patients with heart failure with reduced ejection fraction and multivessel disease (coronary artery stenosis >50% in >= 2 vessels or left main) who underwent coronary angiography between 2000 and 2018 in Sweden. We used a propensity score-adjusted logistic and Cox proportional-hazards regressions and instrumental variable model to adjust for known and unknown confounders. Multilevel modelling was used to adjust for the clustering of observations in a hierarchical database. In total, 2509 patients (82.9% men) were included; 35.8% had diabetes and 34.7% had a previous myocardial infarction. The mean age was 68.19.4years (47.8% were >70years old), and 64.9% had three-vessel or left main disease. Primary designated therapy was PCI in 56.2% and CABG in 43.8%. Median follow-up time was 3.9years (range 1 day to 10years). There were 1010 deaths. Risk of death was lower after CABG than after PCI [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.41-0.96; P=0.031]. The risk of death increased linearly with quintiles of hospitals in which PCI was the preferred method for revascularization (OR 1.27, 95% CI 1.17-1.38, P-trend < 0.001). Conclusion In patients with ischaemic heart failure, long-term survival was greater after CABG than after PCI. [GRAPHICAL ABSTRACT] Study flowchart, time-to-first-event curves through 10-year follow-up and risk-estimate for the primary endpoint - all - cause mortality.

Automated summary

In patients with heart failure due to ischaemic heart disease, coronary artery bypass grafting (CABG) was associated with greater long-term survival compared to percutaneous coronary intervention (PCI). The risk of death was lower after CABG, and increased linearly with quintiles of hospitals where PCI was the preferred revascularization method.