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Observational Study
. 2023 Aug;10(4):2656-2663.
doi: 10.1002/ehf2.14445. Epub 2023 Jun 27.

Mortality rate after coronary revascularization in heart failure patients with coronary artery disease

Vanessa Nader  1   2   3 , Anthony Matta  4   5 , Ryeonshi Kang  1   2 , Antoine Deney  1 , Rania Azar  6 , Charlotte Rouzaud-Laborde  3   7 , Oxana Kunduzova  3 , Romain Itier  1 , Pauline Fournier  1 , Michel Galinier  1   2 , Didier Carrié  1   2 , Jerome Roncalli  1   2   3
Affiliations
Observational Study

Mortality rate after coronary revascularization in heart failure patients with coronary artery disease

Vanessa Nader et al. ESC Heart Fail. 2023 Aug.

Abstract

Aims: Coronary artery disease (CAD) is a common cause of heart failure (HF). It remains unclear who, when and why to direct towards coronary revascularization. The outcomes of coronary revascularization in HF patients are still a matter of debate nowadays. This study aims to evaluate the effect of revascularization strategy on all-cause of death in the context of ischaemic HF.

Methods and results: An observational cohort was conducted on 692 consecutive patients who underwent coronary angiography at the University Hospital of Toulouse between January 2018 and December 2021 for either a recent diagnosis of HF or a decompensated chronic HF, and in whom coronary angiograms showed at least 50% obstructive coronary lesion. The study population was divided into two groups according to the performance or not of a coronary revascularization procedure. The living status (alive or dead) of each of the study's participants was observed by April 2022. Seventy-three per cent of the study population underwent coronary revascularization either by percutaneous coronary intervention (66.6%) or coronary artery bypass grafting (6.2%). Baseline characteristics including age, sex and cardiovascular risk factors did not differ between the invasive and conservative groups, respectively. Death occurred in 162 study participants resulting in an all-cause mortality rate of 23.5%; 26.7% of observed deaths have occurred in the conservative group versus 22.2% in the invasive group (P = 0.208). No difference in survival outcomes has been observed over a mean follow-up period of 2.5 years (P = 0.140) even after stratification by HF categories (P = 0.132) or revascularization modalities (P = 0.366).

Conclusions: Findings from the present study showed comparable all-cause mortality rates between groups. Coronary revascularization does not modify short-term survival outcomes in HF patients compared with optimal medical therapy alone outside the setting of acute coronary syndrome.

Keywords: Coronary artery disease; Coronary revascularization; Heart failure.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Free‐event survival analysis between study groups (revascularized vs. OMT group) stratified by heart failure categories. HFmrEF, heart failure with mid‐range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.
Figure 3
Figure 3
Free‐event survival analysis according to the state of heart failure (acute heart failure versus decompensated chronic heart failure).
Figure 4
Figure 4
Free‐event survival analysis stratified by the revascularization technique. CABG, coronary artery bypass graft; OMT, optimal medical treatment alone; PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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