Coronary artery bypass grafting versus percutaneous coronary intervention in heart failure with reduced left ventricular ejection fraction

Background The present study aims to compare the 10-year outcomes of patients with heart failure and left ventricular systolic dysfunction undergoing myocardial revascularization through coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods This retrospective, single-center study enrolled 707 patients (pts) treated with CABG (429 pts) or PCI (278 pts) for multivessel coronary artery disease and left ventricular systolic dysfunction (LVEF <50 %). Data were collected between January 2002 and December 2023. Preoperative covariates were adjusted using 1:1 propensity-score matching. The primary endpoints were 30-day and long-term all-cause mortality. Secondary endpoints included the incidence of stroke and repeat target revascularization. Results After propensity-score matching, 196 comparable pairs were identified. The 30-day mortality rates were similar between the groups (CABG: 6 pts., 3.1 % vs. PCI: 5 pts., 2.6 %; p = 0.99). At the 10-year follow-up, CABG group showed higher overall survival (CABG: 55 % vs. PCI: 37 %, p < 0.001), a lower incidence of cardiac death (CABG: 12.3 % vs. PCI: 23.4 %, p = 0.049) and repeat target revascularization (CABG: 7.4 % vs. PCI: 23.4 %, p = 0.003). The incidence of stroke was comparable between the two groups (CABG: 5.3 % vs. PCI: 10.2 %, p = 0.440). Conclusions Early outcomes were comparable between PCI and CABG. However, at 10 years, CABG was associated with superior overall survival, lower cardiac death and reduced repeat revascularization rates. Therefore, surgical revascularization should be strongly considered in patients with multivessel coronary artery disease and heart failure with left ventricular systolic dysfunction to achieve long-term survival benefits.