Complete percutaneous revascularisation feasibility in ischaemic heart failure is related to improved outcomes: insights from the COMMIT-HF registry.
OBJECTIVE
Heart failure (HF) is a major cause of death in cardiovascular disease. In a post-STICH landscape, we lack data on the role of percutaneous coronary intervention (PCI) in systolic HF patients. Complete revascularisation remains a key unanswered question in ischaemic HF.


METHODS
The COMMIT-HF is an ongoing systolic HF registry (inclusion criteria: HF with left ventricular ejection fraction ≤ 35%, exclusion: acute coronary syndrome). A total of 1798 patients were enrolled. A group of patients with multi-vessel coronary artery disease qualified for PCI were selected and divided into complete (n = 188) and incomplete revascularisation (n = 159) groups. Completeness of revascularisation was defined as successful PCI of every angiographically significant lesion in all arteries with a diameter of ≥ 2 mm without a patent surgical graft. Patients were followed up for a period of at least 12 months with all-cause mortality defined as the primary endpoint.


RESULTS
The study groups showed no significant differences in clinical status and echocardiographic parameters, with a lower comorbidity rate in the complete revascularisation group. Procedural characteristics were comparable. There were no significant differences in complication rates. All-cause mortality was significantly lower in the complete revascularisation group after 12-months (6.4% vs. 20.1%, p < 0.001). Multivariate analysis confirmed that achievement of complete revascularisation was an independent factor improving survival (HR 0.39; 95% CI 0.18-0.81, p = 0.01).


CONCLUSIONS
Percutaneous coronary intervention can be a safe and feasible method of revascularisation in ischaemic HF. Achievement of complete revascularisation with PCI was related to improved outcomes in the analysed patient population.
wookash.p@gmail.com.
Łukasz
Ł
Pyka
Michał
M
Hawranek
Mateusz
M
Tajstra
Jarosław
J
Gorol
Andrzej
A
Lekston
Mariusz
M
Gąsior
D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007511:Ischemia; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011044:Poland; D012042:Registries; D016896:Treatment Outcome
coronary artery disease; heart failure; percutaneous coronary intervention