In-Hospital Outcomes of Revascularization in Patients with Left Ventricular Systolic Dysfunction and Coronary Chronic Total Occlusion

Authors

  • Yuchao Zhang Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 100029 Beijing, China
  • Zheng Wu Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 100029 Beijing, China
  • Shaoping Wang Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 100029 Beijing, China
  • Jinghua Liu Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 100029 Beijing, China

DOI:

https://doi.org/10.59958/hsf.7637

Keywords:

percutaneous coronary intervention, coronary artery bypass grafting, left ventricular systolic dysfunction, chronic total occlusion

Abstract

Background: The in-hospital outcomes of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with left ventricular systolic dysfunction (LVSD) and chronic total occlusion (CTO) remain unclear. Methods: From 2014 to 2020, patients with LVSD and CTO who underwent PCI or CABG were collected. The primary endpoint was in-hospital major adverse cardiac or cerebrovascular events (MACCE), defined as the composite of all-cause mortality, cardiovascular mortality, stroke, myocardial infarction (MI), and target vessel revascularization. Inverse probability of treatment weighting (IPTW) was performed to evaluate the association between revascularization strategies and in-hospital outcomes. The hazard ratio (HR) and 95% confidence interval (CI) were calculated using the Cox proportional hazards model. Results: Of the 773 patients who met the inclusion criteria, 543 (70.2%) underwent PCI, and 230 (29.8%) underwent CABG. The primary endpoint was observed in 25 (3.2%) patients. The incidence of in-hospital MACCE (6.5% vs. 1.8%, p < 0.001) was significantly higher in the CABG group than in the PCI group. After IPTW, the risk of in-hospital MACCE was not found to be significantly different between CABG and PCI groups (HR = 1.81; 95% CI: 0.37–8.82; p = 0.460). Compared with patients who underwent PCI, those who underwent CABG exhibited a significantly higher risk of MI (HR = 6.92; 95% CI: 1.24–38.60; p = 0.027). Conclusions: Patients with LVSD and CTO could experience better outcomes with PCI, which offers a safer alternative coronary revascularization strategy and a reduced risk of MI.

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Published

2024-07-08

How to Cite

Zhang, Y., Wu, Z., Wang, S., & Liu, J. (2024). In-Hospital Outcomes of Revascularization in Patients with Left Ventricular Systolic Dysfunction and Coronary Chronic Total Occlusion. The Heart Surgery Forum, 27(7), E733-E743. https://doi.org/10.59958/hsf.7637

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