Department of Cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France.
Faculty of Sciences, Paul-Sabatier Toulouse III University, Toulouse, France.
ESC Heart Fail. 2023 Aug;10(4):2656-2663. doi: 10.1002/ehf2.14445. Epub 2023 Jun 27.
Coronary artery disease (CAD) is a common cause of heart failure (HF). It remains unclear who, when and why to direct towards coronary revascularization. The outcomes of coronary revascularization in HF patients are still a matter of debate nowadays. This study aims to evaluate the effect of revascularization strategy on all-cause of death in the context of ischaemic HF.
An observational cohort was conducted on 692 consecutive patients who underwent coronary angiography at the University Hospital of Toulouse between January 2018 and December 2021 for either a recent diagnosis of HF or a decompensated chronic HF, and in whom coronary angiograms showed at least 50% obstructive coronary lesion. The study population was divided into two groups according to the performance or not of a coronary revascularization procedure. The living status (alive or dead) of each of the study's participants was observed by April 2022. Seventy-three per cent of the study population underwent coronary revascularization either by percutaneous coronary intervention (66.6%) or coronary artery bypass grafting (6.2%). Baseline characteristics including age, sex and cardiovascular risk factors did not differ between the invasive and conservative groups, respectively. Death occurred in 162 study participants resulting in an all-cause mortality rate of 23.5%; 26.7% of observed deaths have occurred in the conservative group versus 22.2% in the invasive group (P = 0.208). No difference in survival outcomes has been observed over a mean follow-up period of 2.5 years (P = 0.140) even after stratification by HF categories (P = 0.132) or revascularization modalities (P = 0.366).
Findings from the present study showed comparable all-cause mortality rates between groups. Coronary revascularization does not modify short-term survival outcomes in HF patients compared with optimal medical therapy alone outside the setting of acute coronary syndrome.
冠心病（CAD）是心力衰竭（HF）的常见病因。目前仍不清楚谁、何时以及为何需要进行冠状动脉血运重建。HF 患者进行冠状动脉血运重建的结果仍存在争议。本研究旨在评估在缺血性 HF 背景下，血运重建策略对全因死亡的影响。
对 2018 年 1 月至 2021 年 12 月在图卢兹大学医院因近期 HF 诊断或失代偿性慢性 HF 而行冠状动脉造影的 692 例连续患者进行了一项观察性队列研究，且冠状动脉造影显示至少有 50%的阻塞性冠状动脉病变。根据是否进行冠状动脉血运重建术将研究人群分为两组。截至 2022 年 4 月，观察每个研究参与者的生存状况（存活或死亡）。研究人群中 73%接受了冠状动脉血运重建，包括经皮冠状动脉介入治疗（66.6%）或冠状动脉旁路移植术（6.2%）。两组患者的基线特征（年龄、性别和心血管危险因素）无差异。162 名研究参与者死亡，总死亡率为 23.5%；保守组观察到的死亡人数为 26.7%，介入组为 22.2%（P=0.208）。即使在 HF 类别（P=0.132）或血运重建方式（P=0.366）分层后，平均 2.5 年的随访期间也未观察到生存结果存在差异（P=0.140）。
本研究结果显示两组全因死亡率相当。与单独最佳药物治疗相比，冠状动脉血运重建不能改善急性冠状动脉综合征以外的 HF 患者的短期生存结局。
