Revascularization and outcomes in ischaemic left ventricular dysfunction after heart failure admission : The RevascHeart study
Moliner-Abós, Carles (Universitat Autònoma de Barcelona)
Calvo-Barceló, Maria (Hospital Universitari Vall d'Hebron)
Solé-Gonzalez, Eduard (Hospital Clínic i Provincial de Barcelona)
Borrellas Martín, Andrea (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Fluvià Brugués, Paula (Hospital Universitari de Girona Doctor Josep Trueta)
Sánchez-Vega, Jesús (Hospital Universitari de Bellvitge)
Taurón Ferrer, Manel (Institut de Recerca Sant Pau)
Tobías-Castillo, Pablo E. (Hospital Universitari Vall d'Hebron)
de la Fuente Mancera, Juan Carlos (Hospital Clínic i Provincial de Barcelona)
Vilardell Rigau, Pau (Hospital Universitari de Girona Doctor Josep Trueta)
Vila-Olives, Rosa (Hospital Universitari Vall d'Hebron)
Bayés-Genís, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Arzamendi, Dabit (Universitat Autònoma de Barcelona. Departament de Medicina)
Ferreira-Gonzalez, Ignacio (Hospital Universitari Vall d'Hebron)
Mirabet Pérez, Sonia (Universitat Autònoma de Barcelona. Departament de Medicina)

Fecha:	2025
Resumen:	Aims: Despite numerous trials on revascularization in patients with heart failure (HF) and ischaemic left ventricular (LV) dysfunction, its role remains unsettled. Guideline-directed medical therapy (GDMT) for HF has shown benefits on outcomes. This multicentre study aims to compare long-term mortality between revascularization and GDMT in patients with ischaemic LV dysfunction following admission for HF. Methods and results: Between 2012 and 2023, 408 patients admitted for HF with a LV ejection fraction (LVEF) of 40% or less and documented coronary artery disease (CAD) were included. Patients were categorized into two groups based on their initial treatment decision: revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass graft [CABG]) or GDMT. The primary outcome was rate of all-cause or cardiovascular mortality, and secondary outcomes included type of revascularization (PCI vs. CABG) and LV reverse remodelling. After a median 44. 6-month follow-up, 100 patients (33%) died in the revascularization group, compared to 44 (43%) in the GDMT group. Multivariate analysis showed no significant benefit of revascularization on all-cause mortality (hazard ratio [HR] 0. 81, 95% confidence interval [CI] 0. 48-1. 39, p = 0. 45) or cardiovascular mortality (HR 0. 97, 95% CI 0. 62-1. 52, p = 0. 90) compared to GDMT. Neither CABG (HR 0. 74, 95% CI 0. 51-1. 08, p = 0. 13) nor PCI (HR 0. 98, 95% CI 0. 62-1. 55, p = 0. 93) demonstrated a mortality reduction compared to GDMT. Both groups experienced significant reductions in LV size and improvements in LVEF, greater in the revascularization group. Conclusion: Revascularization did not outperform GDMT in ischaemic LV dysfunction following HF admission in this retrospective analysis. Larger prospective studies are needed to clarify the potential role of revascularization in improving outcomes.
Ayudas:	Instituto de Salud Carlos III CM21/00245 Ministerio de Economía y Competitividad CB16/11/00276
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Lengua:	Anglès
Documento:	Article ; recerca ; Versió acceptada per publicar
Materia:	Ischemic left ventricular dysfunction ; Ischemic heart failure ; Revascularization ; GDMT
Publicado en:	European Journal of Heart Failure, Vol. 27, Num. 3 (March 2025) , p. 598-605, ISSN 1879-0844

DOI: 10.1002/ejhf.3463

19 p, 245.0 KB

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