BACKGROUND AND AIMS The optimal revascularization strategy in patients with ischaemic cardiomyopathy remains unclear with no contemporary randomized trial data to guide clinical practice. This study aims to assess long-term survival in patients with severe ischaemic cardiomyopathy revascularized by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). METHODS Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons and Melbourne Interventional Group registries (from January 2005 to 2018), patients with severe ischaemic cardiomyopathy [left ventricular ejection fraction (LVEF) <35%] undergoing PCI or isolated CABG were included in the analysis. Those with ST-elevation myocardial infarction and cardiogenic shock were excluded. The primary outcome was long-term National Death Index-linked mortality up to 10 years following revascularization. Risk adjustment was performed to estimate the average treatment effect using propensity score analysis with inverse probability of treatment weighting (IPTW). RESULTS A total of 2042 patients were included, of whom 1451 patients were treated by CABG and 591 by PCI. Inverse probability of treatment weighting-adjusted demographics, procedural indication, coronary artery disease extent, and LVEF were well balanced between the two patient groups. After risk adjustment, patients treated by CABG compared with those treated by PCI experienced reduced long-term mortality [adjusted hazard ratio 0.59, 95% confidence interval (CI) 0.45-0.79, P = .001] over a median follow-up period of 4.0 (inter-quartile range 2.2-6.8) years. There was no difference between the groups in terms of in-hospital mortality [adjusted odds ratio (aOR) 1.42, 95% CI 0.41-4.96, P = .58], but there was an increased risk of peri-procedural stroke (aOR 19.6, 95% CI 4.21-91.6, P < .001) and increased length of hospital stay (exponentiated coefficient 3.58, 95% CI 3.00-4.28, P < .001) in patients treated with CABG. CONCLUSIONS In this multi-centre IPTW analysis, patients with severe ischaemic cardiomyopathy undergoing revascularization by CABG rather than PCI showed improved long-term survival. However, future randomized controlled trials are needed to confirm the effect of any such benefits.

中文翻译：

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冠状动脉旁路移植术与经皮冠状动脉介入治疗严重缺血性心肌病：长期生存率。


背景和目的缺血性心肌病患者的最佳血运重建策略仍不清楚，没有当代随机试验数据来指导临床实践。本研究旨在评估通过冠状动脉旁路移植术 （CABG） 或经皮冠状动脉介入治疗 （PCI） 血运重建的严重缺血性心肌病患者的长期生存率。方法 使用澳大利亚和新西兰心胸外科医师协会和墨尔本介入组登记处 （从 2005 年 1 月到 2018年），将接受 PCI 或孤立 CABG 的严重缺血性心肌病 [左心室射血分数 （LVEF） <35%] 患者纳入分析。排除 ST 段抬高型心肌梗死和心源性休克患者。主要结局是血运重建后长达 10 年的长期全国死亡指数相关死亡率。使用治疗加权逆概率 （IPTW） 的倾向评分分析进行风险调整以估计平均治疗效果。结果 共纳入 2042 例患者，其中 1451 例接受 CABG 治疗，591 例接受 PCI 治疗。治疗加权调整后的人口统计学、手术适应症、冠状动脉疾病范围和 LVEF 的逆概率在两个患者组之间取得了很好的平衡。风险调整后，与接受 PCI 治疗的患者相比，CABG 治疗的患者在中位随访期为 4.0 （四分位距 2.2-6.8） 年内，长期死亡率降低 [调整后风险比 0.59,95% 置信区间 （CI） 0.45-0.79，P = .001]。两组之间在院内死亡率方面没有差异 [校正比值比 （aOR） 1.42,95% CI 0.41-4.96，P = .58]，但接受 CABG 治疗的患者围手术期卒中风险增加 （aOR 19.6,95% CI 4.21-91.6，P < .001） 和住院时间增加 （指数系数 3.58,95% CI 3.00-4.28，P < .001）。结论 在这项多中心 IPTW 分析中，接受 CABG 而不是 PCI 血运重建的严重缺血性心肌病患者显示出更高的长期生存率。然而，需要未来的随机对照试验来确认任何此类益处的效果。