title: Three-year outcomes after percutaneous coronary intervention and coronary artery bypass grafting in patients with heart failure: from the CREDO-Kyoto percutaneous coronary intervention/coronary artery bypass graft registry cohort-2†.
abstract: OBJECTIVE
  Ischaemic heart disease is a major risk factor for heart failure. However, long-term benefit of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in those patients has not been well elucidated.
  
  
  METHODS
  Of the 15 939 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2, we identified 1064 patients with multivessel and/or left main disease with a history of heart failure (ACC/AHA Stage C or D).
  
  
  RESULTS
  There were 672 patients undergoing PCI and 392 CABG. Preprocedural left ventricular ejection fraction was not different between PCI and CABG (46.6 ± 15.1 vs 46.6 ± 14.6%, P = 0.89), but the CABG group included more patients with triple-vessel and left main disease (P < 0.01 each). Three-year outcomes revealed that the risk of hospital readmission for heart failure was higher after PCI than after CABG (hazard ratio [95% confidence interval]; 1.90 [1.18-3.05], P = 0.01). More importantly, adjusted mortality after PCI was significantly higher than after CABG (1.79 [1.13-2.82], P = 0.01). The risk of cardiac death after PCI was also higher than after CABG (1.98 [1.10-3.55], P = 0.02). Stratified analysis using the SYNTAX score demonstrated that risk of death was not different between PCI and CABG in patients with low (<23) and intermediate (23-32) SYNTAX scores (2.10 [0.57-7.68], P = 0.26 and 1.43 [0.63-3.21], P = 0.39, respectively), whereas those with a high (≥ 33) SYNTAX score, the risk of death was far higher after PCI than after CABG (4.83 [1.46-16.0], P = 0.01).
  
  
  CONCLUSIONS
  In patients with heart failure with advanced coronary artery disease, CABG was a better option than PCI because CABG was associated with better survival benefit, particularly in more complex coronary lesions stratified by the SYNTAX score.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan marui@kuhp.kyoto-u.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Marui
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Cardiovascular Surgery, Nara Hospital Kinki University Faculty of Medicine, Ikoma, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Nishiwaki
authors.affiliation: Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Komiya
authors.affiliation: Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Michiya
authors.initials: M
authors.lastname: Hanyu
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.affiliation: Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D018487:Ventricular Dysfunction, Left / Q000601:surgery
keywords: Coronary artery bypass grafting; Heart failure; Left ventricular dysfunction; Percutaneous coronary intervention; SYNTAX score