DOI: 10.1161/circ.148.suppl_1.14858 ISSN: 0009-7322

Abstract 14858: Revascularization Shows Beneficial Cardiovascular Outcomes in Severe Ischemic Cardiomyopathy: A Systematic Review and Meta-Analysis

Shumail Fatima, Abu Hurera, Midori Torpoco Rivera, Ahmet Sezer, Gavin W Hickey
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Revascularization approach is historically prioritized over optimal medical therapy (OMT) for patients with severe stable ischemic cardiomyopathy (ICM) with ejection fraction < 35%. However, with advancement in OMT, recent studies have shown similar cardiovascular outcomes between the two strategies. Herein, we present a systematic review and meta-analysis examining the cardiovascular outcomes of revascularization strategies compared to OMT.

Research Question: Is revascularization associated with improved cardiovascular outcomes in patients with severe stable ICM compared to OMT alone?

Methods: PubMed, Embase, Cochrane,, ICTRP were searched using the search terms “coronary artery bypass grafting (CABG)” or “percutaneous coronary intervention (PCI)” versus “OMT” and “ICM” or “heart failure (HF)” from inception till May 2023. Included studies compared all-cause mortality, cardiovascular mortality, HF-related deaths, acute myocardial infarction (AMI), stroke and HF hospitalization. Data were pooled into risk ratios (RR) using fixed-effects model.

Results: 3 studies (n= 2050, Revascularization = 1026 and OMT= 1024) met our inclusion criteria. The follow-up period ranged from 3.4-9.8 years. Revascularization strategies primarily through CABG had protective effects for all-cause mortality (RR 0.91, 95% CI 0.84-0.98, p= 0.01, I2 0%, N= 3 studies), cardiovascular death (RR 0.83, 95% CI 0.74-0.93, p=0.00, I2 0%, N= 2 studies) and HF hospitalizations (RR 0.80, 95% CI 0.69-0.93, p= 0.00, I2 19.20%, N= 2 studies). No significant differences were observed in risks of HF related deaths, AMI and stroke between the two strategies.

Conclusions: Revascularization primarily through CABG reduces all-cause and cardiovascular mortality as well as HF hospitalizations in severe stable ICM. Further studies are warranted to determine which patients can derive the greatest advantages from revascularization.

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