Institute of Health Policy, Management and Evaluation.
Division of Cardiac Surgery, University of Toronto, Toronto, Ontario.
Curr Opin Cardiol. 2022 Nov 1;37(6):474-480. doi: 10.1097/HCO.0000000000001000. Epub 2022 Sep 12.
Coronary artery disease (CAD) is responsible for >50% of heart failures cases. Patients with ischemic left ventricular systolic dysfunction (iLVSD) are known to have poorer outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) compared to patients with a normal ejection fraction. Nevertheless, <1% of patients in coronary revascularization trials to date had iLVSD. The purpose of this review is to describe coronary revascularization modalities in patients with iLVSD and highlight the need for randomized controlled trial evidence comparing these treatments in this patient population.
Network meta-analytic findings of observational studies suggest that PCI is associated with higher rates of mortality, cardiac death, myocardial infarction, and repeat revascularization but not stroke compared to CABG in iLVSD. In recent years, outcomes for patients undergoing PCI have improved as a result of advances in technologies and techniques.
The optimal coronary revascularization modality in patients with iLVSD remains unknown. In observational studies, CABG appears superior to PCI; however, direct randomized evidence is absent and developments in PCI techniques have improved post-PCI outcomes in recent years. The Surgical Treatment for Ischemic Heart Failure 3.0 consortium of trials will seek to address the clinical equipoise in coronary revascularization in patients with iLVSD.
冠心病（CAD）是导致 >50%心力衰竭病例的原因。与射血分数正常的患者相比，有缺血性左心室收缩功能障碍（iLVSD）的患者在经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）后预后更差。然而，迄今为止，在冠状动脉血运重建试验中，仅有 <1%的患者患有 iLVSD。本文旨在描述 iLVSD 患者的冠状动脉血运重建方式，并强调需要随机对照试验证据来比较这些治疗方法在该患者人群中的疗效。
来自观察性研究的网络荟萃分析结果表明，与 CABG 相比，iLVSD 患者接受 PCI 治疗后死亡率、心脏性死亡、心肌梗死和再次血运重建的发生率更高，但卒中发生率无差异。近年来，由于技术和技术的进步，接受 PCI 治疗的患者的预后得到了改善。
iLVSD 患者的最佳冠状动脉血运重建方式仍不清楚。在观察性研究中，CABG 似乎优于 PCI；然而，目前缺乏直接的随机证据，近年来 PCI 技术的发展改善了 PCI 后的预后。缺血性心力衰竭 3.0 期手术治疗联盟的试验将旨在解决 iLVSD 患者冠状动脉血运重建的临床平衡点。
