1
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Kirov H, Fischer J, Caldonazo T, Tasoudis P, Runkel A, Soletti GJ, Cancelli G, Dell'Aquila M, Mukharyamov M, Doenst T. Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion. Thorac Cardiovasc Surg 2024. [PMID: 38759955 DOI: 10.1055/s-0044-1787014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Mechanisms of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) differ as CABG provides surgical collateralization and may prolong life by preventing future myocardial infarctions (MIs). However, evidence for CABG in patients with chronic total occlusion (CTO) has not been fully elucidated and the impact of PCI is discussed controversially. METHODS We performed a meta-analysis of studies comparing outcomes in patients with/without multivessel disease undergoing CABG or PCI for CTO. The primary outcome was long-term all-cause mortality (≥5 years). Secondary outcomes were MIs, repeat revascularization, cardiac mortality, major adverse cardiovascular events, and stroke, as well as short-term mortality (30 days/in-hospital) and stroke. A pooled Kaplan-Meier survival curve after reconstruction analysis was generated. Random-effects models were used. RESULTS Six studies totaling 12,504 patients were included. In the pooled Kaplan-Meier analysis, PCI showed a significantly higher risk of death in the follow-up compared with CABG (hazard ratio [HR]: 2.12, 95% confidence interval [CI]: 1.88-2.38, p < 0.01). During the observation period, PCI was also associated with higher rates of MI (odds ratio [OR]: 2.86, 95% CI: 1.82-4.48, p < 0.01) and more repeat revascularization (OR: 4.88, 95% CI: 1.99-11.91, p = 0.0005). The other outcomes did not show significant differences. CONCLUSION CABG is associated with superior survival to PCI over time in patients with CTO who are eligible for both PCI and CABG. This survival advantage is associated with fewer events of MI and repeat revascularization.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, United States
| | - Angelique Runkel
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | | | | | | | - Murat Mukharyamov
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
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2
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Wang K, Wang L, Cong H, Zhang J, Hu Y, Zhang Y, Zhang R, Li W, Qi W. A comparison of drug-eluting stent and coronary artery bypass grafting in mildly to moderately ischemic heart failure. ESC Heart Fail 2022; 9:1749-1755. [PMID: 35194977 PMCID: PMC9065860 DOI: 10.1002/ehf2.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 11/16/2022] Open
Abstract
Aims The best revascularization strategy for patients with ischaemic heart failure (IHF) remains unclear. Current evidence and guidelines mainly focus on patients with severe ischaemic heart failure (ejection fraction [EF] < 35%). There are limited data comparing clinical outcomes of coronary artery bypass grafting (CABG) with implantation of drug‐eluting stents (DESs) in patients with mild to moderate ischaemic heart failure (EF 35–50%). It is therefore unknown whether percutaneous coronary intervention (PCI) with DES implantation can provide comparable outcomes to CABG in these patients. Methods and results From January 2016 to December 2017, we enrolled patients with mildly to moderately reduced EF (35–50%) who had undergone PCI with DESs or CABG. Patients with a history of CABG, presented with acute ST‐elevation myocardial infarction (MI) or acute heart failure, and patients who had undergone CABG concomitant valvular or aortic surgery were excluded. Propensity score‐matching analysis was performed between the two groups. Kaplan–Meier analysis and multivariate Cox proportional hazard regression were applied to assess all‐cause mortality and individual end points. A total of 2050 patients (1330 PCIs and 720 CABGs) were included, and median follow‐up was 45 months (interquartile range 40 to 54). There were significant differences in all‐cause death between the two groups: 77 patients in the PCI group and 27 in the CABG group (DES vs. CABG: 5.8% vs. 3.8%, P = 0.045). After propensity score matching for the entire population, 601 matched pairs were obtained. The long‐term cumulative rate of all‐cause death was significantly different between the two groups (DES vs. CABG: 5.8% vs. 2.7%, P = 0.006). No differences were found in the rates of cardiac death (DES vs. CABG: 4.8% vs. 3.0%, P = 0.096), recurrent MI (DES vs. CABG: 4.0% vs. 2.8%, P = 0.234), and stroke (DES vs. CABG: 6.8% vs. 5.2%, P = 0.163). The rate of repeat coronary revascularization was significantly higher in the PCI group than in the CABG group (12.1% vs. 6.0%, P = 0.000). Conclusions Considering the higher long‐term survival rate and lower repeat‐revascularization rate, CABG may be superior to DES implantation in patients with mildly to moderately reduced EF (35–50%) and significant CAD.
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Affiliation(s)
- Kun Wang
- Tianjin Medical University Graduate School, Tianjin, China
| | - Le Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Hongliang Cong
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jingxia Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yuecheng Hu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yingyi Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Rui Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wenyu Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wei Qi
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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3
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Tajabadi M, Goran Orimi H, Ramzgouyan MR, Nemati A, Deravi N, Beheshtizadeh N, Azami M. Regenerative strategies for the consequences of myocardial infarction: Chronological indication and upcoming visions. Biomed Pharmacother 2021; 146:112584. [PMID: 34968921 DOI: 10.1016/j.biopha.2021.112584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022] Open
Abstract
Heart muscle injury and an elevated troponin level signify myocardial infarction (MI), which may result in defective and uncoordinated segments, reduced cardiac output, and ultimately, death. Physicians apply thrombolytic therapy, coronary artery bypass graft (CABG) surgery, or percutaneous coronary intervention (PCI) to recanalize and restore blood flow to the coronary arteries, albeit they were not convincingly able to solve the heart problems. Thus, researchers aim to introduce novel substitutional therapies for regenerating and functionalizing damaged cardiac tissue based on engineering concepts. Cell-based engineering approaches, utilizing biomaterials, gene, drug, growth factor delivery systems, and tissue engineering are the most leading studies in the field of heart regeneration. Also, understanding the primary cause of MI and thus selecting the most efficient treatment method can be enhanced by preparing microdevices so-called heart-on-a-chip. In this regard, microfluidic approaches can be used as diagnostic platforms or drug screening in cardiac disease treatment. Additionally, bioprinting technique with whole organ 3D printing of human heart with major vessels, cardiomyocytes and endothelial cells can be an ideal goal for cardiac tissue engineering and remarkable achievement in near future. Consequently, this review discusses the different aspects, advancements, and challenges of the mentioned methods with presenting the advantages and disadvantages, chronological indications, and application prospects of various novel therapeutic approaches.
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Affiliation(s)
- Maryam Tajabadi
- School of Metallurgy and Materials Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran 16844, Iran
| | - Hanif Goran Orimi
- School of Metallurgy and Materials Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran 16844, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Maryam Roya Ramzgouyan
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Alireza Nemati
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Beheshtizadeh
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mahmoud Azami
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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4
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Yamamoto K, Matsumura-Nakano Y, Shiomi H, Natsuaki M, Morimoto T, Kadota K, Tada T, Takeji Y, Yoshikawa Y, Imada K, Domei T, Kaneda K, Taniguchi R, Ehara N, Nawada R, Yamaji K, Kato E, Toyofuku M, Kanemitsu N, Shinoda E, Suwa S, Iwakura A, Tamura T, Soga Y, Inada T, Matsuda M, Koyama T, Aoyama T, Sato Y, Furukawa Y, Ando K, Yamazaki F, Komiya T, Minatoya K, Nakagawa Y, Kimura T. Effect of Heart Failure on Long-Term Clinical Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Severe Coronary Artery Disease. J Am Heart Assoc 2021; 10:e021257. [PMID: 34323122 PMCID: PMC8475682 DOI: 10.1161/jaha.121.021257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Heart failure might be an important determinant in choosing coronary revascularization modalities. There was no previous study evaluating the effect of heart failure on long-term clinical outcomes after percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG). Methods and Results Among 14 867 consecutive patients undergoing first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013 in the CREDO-Kyoto PCI/CABG registry Cohort-3, we identified the current study population of 3380 patients with three-vessel or left main coronary artery disease, and compared clinical outcomes between PCI and CABG stratified by the subgroup based on the status of heart failure. There were 827 patients with heart failure (PCI: N=511, and CABG: N=316), and 2553 patients without heart failure (PCI: N=1619, and CABG: N=934). In patients with heart failure, the PCI group compared with the CABG group more often had advanced age, severe frailty, acute and severe heart failure, and elevated inflammatory markers. During a median 5.9 years of follow-up, there was a significant interaction between heart failure and the mortality risk of PCI relative to CABG (interaction P=0.009), with excess mortality risk of PCI relative to CABG in patients with heart failure (HR, 1.75; 95% CI, 1.28-2.42; P<0.001) and no excess mortality risk in patients without heart failure (HR, 1.04; 95% CI, 0.80-1.34; P=0.77). Conclusions There was a significant interaction between heart failure and the mortality risk of PCI relative to CABG with excess risk in patients with heart failure and neutral risk in patients without heart failure.
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5
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Abstract
Heart failure is a complex clinical syndrome and represents the final path of numerous heart diseases. Coronary artery disease is recognized as the primary risk factor for heart failure development, being the main etiological factor in more than 50% of heart failure patients in North America and Europe. Regardless of overt coronary artery disease, myocardial ischemia is a common finding in failing hearts, likely due to structural or functional coronary circulation alterations. Ischemia is a self-propagating process which irreversibly impairs the cardiac function and negatively impacts prognosis. Thus, a better and thorough understanding of myocardial ischemia pathophysiology in heart failure would likely lead to significantly improved outcomes in these patients. This review aims to describe the mechanisms of myocardial ischemia and coronary artery disease in heart failure, focusing on coronary circulation dysfunctions due to increased parietal stress or non-obstructive coronary disease, and discussing the association and management of coronary artery disease in patients with heart failure.
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Affiliation(s)
- Beniamino R Pagliaro
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Francesco Cannata
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Giulio G Stefanini
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
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6
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Yokokawa T, Yoshihisa A, Kiko T, Shimizu T, Misaka T, Yamaki T, Kunii H, Nakazato K, Ishida T, Takeishi Y. Residual Gensini Score Is Associated With Long-Term Cardiac Mortality in Patients With Heart Failure After Percutaneous Coronary Intervention. Circ Rep 2020; 2:89-94. [PMID: 33693213 PMCID: PMC7929761 DOI: 10.1253/circrep.cr-19-0121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background:
Coronary revascularization is important in heart failure (HF) with ischemic etiology. Coronary scoring systems are useful to evaluate coronary artery disease, but said systems for residual stenosis after revascularization are still poorly understood. Therefore, the aim of the current study was to clarify the prognostic impact of residual stenosis using a coronary scoring system, Gensini score, in HF patients after percutaneous coronary intervention (PCI). Methods and Results:
We analyzed consecutive hospitalized ischemic HF patients (n=199) who underwent PCI. We calculated residual Gensini score after PCI, and divided the patients into 2 groups based on median residual Gensini score. The patients with high scores (≥10, n=101) had a higher prevalence of anemia, lower prevalence of dyslipidemia, and lower left ventricular ejection fraction, compared with those with low scores (<10, n=98). During the median follow-up period of 1,581 days (range, 20–2,896 days), the high-score patients had a higher cardiac mortality than the low-score group (log rank, P=0.001). Conclusions:
In patients with HF after PCI, residual Gensini score was associated with long-term cardiac mortality. Residual Gensini score may be a useful index for risk stratification of HF after PCI.
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Affiliation(s)
- Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan.,Department of Pulmonary Hypertension, Fukushima Medical University Fukushima Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan.,Department of Advanced Cardiac Therapeutics, Fukushima Medical University Fukushima Japan
| | - Takatoyo Kiko
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
| | - Takeshi Shimizu
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan.,Department of Advanced Cardiac Therapeutics, Fukushima Medical University Fukushima Japan
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
| | - Hiroyuki Kunii
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
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7
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Paradigm Shifts of Heart Failure Therapy: Do We Need Another Paradigm? ACTA ACUST UNITED AC 2020; 2:145-156. [PMID: 36262366 PMCID: PMC9536678 DOI: 10.36628/ijhf.2020.0010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 12/21/2022]
Abstract
Heart failure (HF) is a progressive condition with intermittent acute decompensation leading to poor prognosis despite established guideline-directed therapy. A paradigm of HF therapy has been shifted over last four decades. Until the early 1970s, HF was empirically managed, then was managed with the hemodynamic concept until the early 1980s. According to the results of large randomized clinical trials, HF therapy has been shifted to the neurohormonal paradigm since the late 1980s until recently. Korean Acute Heart Failure (KorAHF) registry is a multi-center registry that recruited a total of 5625 admitted patients with acute HF from 2011 to 2014 and followed until 2019. Through KorAHF registry, we could obtain invaluable information or messages in various fields such as epidemiology, clinical characteristics, and treatment of acute HF in Korea and also had opportunities to fill the gap between guideline-directed care and real-world practice. Considering significant unmet needs in HF therapy even at this moment, we do need another paradigm shift for HF therapy, such as molecular and regenerative paradigm using gene, stem cells, mechanical support as well as novel pharmacological agents.
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8
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Sá MPBO, Perazzo ÁM, Saragiotto FAS, Cavalcanti LRP, Almeida ACE, Campos JCS, Braga PGB, Rayol SDC, Diniz RGS, Sá FBCA, Lima RC. Coronary Artery Bypass Graft Surgery Improves Survival Without Increasing the Risk of Stroke in Patients with Ischemic Heart Failure in Comparison to Percutaneous Coronary Intervention: A Meta-Analysis With 54,173 Patients. Braz J Cardiovasc Surg 2019; 34:396-405. [PMID: 31454193 PMCID: PMC6713365 DOI: 10.21470/1678-9741-2019-0170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective To evaluate whether there is any difference on the results of patients
treated with coronary artery bypass grafting (CABG) or percutaneous coronary
intervention (PCI) in the setting of ischemic heart failure (HF). Methods Databases (MEDLINE, Embase, Cochrane Controlled Trials Register
[CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic
Library Online [SciELO], Literatura Latino-americana e do
Caribe em Ciências da Saúde [LILACS], and Google
Scholar) were searched for studies published until February 2019. Main
outcomes of interest were mortality, myocardial infarction, repeat
revascularization, and stroke. Results The search yielded 5,775 studies for inclusion. Of these, 20 articles were
analyzed, and their data were extracted. The total number of patients
included was 54,173, and those underwent CABG (N=29,075) or PCI (N=25098).
The hazard ratios (HRs) for mortality (HR 0.763; 95% confidence interval
[CI] 0.678-0.859; P<0.001), myocardial
infarction (HR 0.481; 95% CI 0.365-0.633; P<0.001), and
repeat revascularization (HR 0.321; 95% CI 0.241-0.428;
P<0.001) were lower in the CABG group than in the PCI
group. The HR for stroke showed no statistically significant difference
between the groups (random effect model: HR 0.879; 95% CI 0.625-1.237;
P=0.459). Conclusion This meta-analysis found that CABG surgery remains the best option for
patients with ischemic HF, without increase in the risk of stroke.
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Affiliation(s)
- Michel Pompeu Barros Oliveira Sá
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil.,Faculty of Medical Sciences and Biological Sciences Institute - FCM/ICB Nucleus of Postgraduate and Research in Health Sciences Recife Pernambuco Brazil Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute - FCM/ICB, Recife, Pernambuco, Brazil
| | - Álvaro Monteiro Perazzo
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Felipe Augusto Santos Saragiotto
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Luiz Rafael Pereira Cavalcanti
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Antônio Carlos Escorel Almeida
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Jéssica Cordeiro Siqueira Campos
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Paulo Guilherme Bezerra Braga
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Sérgio da Costa Rayol
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Roberto Gouvea Silva Diniz
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Frederico Browne Correia Araújo Sá
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Ricardo Carvalho Lima
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Division of Cardiovascular Surgery Recife Pernambuco Brazil Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE Recife Pernambuco Brazil University of Pernambuco - UPE, Recife, Pernambuco, Brazil.,Faculty of Medical Sciences and Biological Sciences Institute - FCM/ICB Nucleus of Postgraduate and Research in Health Sciences Recife Pernambuco Brazil Nucleus of Postgraduate and Research in Health Sciences, Faculty of Medical Sciences and Biological Sciences Institute - FCM/ICB, Recife, Pernambuco, Brazil
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9
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Rayol SC, Sá MPBO, Cavalcanti LRP, Saragiotto FAS, Diniz RGS, Sá FBCDAE, Menezes AMD, Lima RC. Current Practice of State-of-the-Art Coronary Revascularization in Patients with Heart Failure. Braz J Cardiovasc Surg 2019; 34:93-97. [PMID: 30810680 PMCID: PMC6385835 DOI: 10.21470/1678-9741-2018-0335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/10/2019] [Indexed: 11/19/2022] Open
Abstract
The best treatment for patients with ischemic heart failure (HF) is still on
debate. There is growing evidence that coronary artery bypass graft (CABG)
benefits these patients. The current recommendations for revascularization in
this context are that CABG is reasonable when it comes to decreasing morbidity
and mortality rates for patients with severe left ventricular dysfunction
(ejection fraction <35%), and significant coronary artery disease (CAD) and
should be considered in patients with operable coronary anatomy, regardless
whether or not there is a viable myocardium (class IIb). Percutaneous coronary
intervention (PCI) does not have enough data to allow the panels to reach a
conclusion. The Korean Acute Heart Failure registry (KorAHF) had its data
released recently, showing that patients with acute HF who underwent CABG had
lower death rates, more complete revascularization and less adverse outcomes
compared with patients treated with PCI. Recent ESC/EACTS guidelines on
myocardial revascularization clearly recommended CABG as the first choice of
revascularization strategy in patients with multivessel disease and acceptable
surgical risk to improve prognosis in this scenario of left ventricular
dysfunction. However, a high peri-procedural risk must be compared with the
benefit of late mortality, and pros and cons of each strategy (either PCI or
CABG) must be weighed in the decision-making process. Spurred on by the
publication of the above-mentioned article and the release of new guidelines, we
went on to write an overview of the current practice of state-of-the-art
coronary revascularization options in patients with HF.
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Affiliation(s)
- Sérgio Costa Rayol
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Michel Pompeu Barros Oliveira Sá
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil.,Nucleus of Postgraduate Studies and Research in Health Sciences of Faculdade de Ciências Médicas and Instituto de Ciências Biológicas (FCM/ICB), Recife, PE, Brazil
| | - Luiz Rafael Pereira Cavalcanti
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Felipe Augusto Santos Saragiotto
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Roberto Gouvea Silva Diniz
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Frederico Browne Correia de Araújo E Sá
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Alexandre Motta de Menezes
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Ricardo Carvalho Lima
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil.,Nucleus of Postgraduate Studies and Research in Health Sciences of Faculdade de Ciências Médicas and Instituto de Ciências Biológicas (FCM/ICB), Recife, PE, Brazil
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Kubrusly FB, Machado-Junior PAB. Coronary Artery Bypass Grafting in Acute Ischemic Heart Failure: Where do We Stand? (And Where Should We Go?). Braz J Cardiovasc Surg 2018; 33:II-III. [PMID: 30517249 PMCID: PMC6257530 DOI: 10.21470/1678-9741-2018-0329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Fernando B Kubrusly
- Incor Curitiba, Instituto Denton Cooley, Hospital do Coração de Curitiba, Curitiba, PR, Brazil
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