CABG Versus PCI in Heart Failure with Reduced Ejection Fraction Patients: A Systematic Review & Meta-analysis Stratified by Left Ventricular Ejection Fraction

Abstract Background Comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with heart failure with reduced ejection fraction (HFrEF) remains controversial within the literature. The current meta-analysis aimed to compare CABG and PCI in HFrEF patients regarding mortality and long-term survival, repeat revascularization, new postoperative myocardial infarction (MI) and stroke, stratified by the degree of LVEF reduction. Methods In a systematic review, a comprehensive literature search was conducted on multiple electronic databases using strict search terms. Twenty studies met the set inclusion/exclusion criteria. Meta-analysis of extracted data was conducted using the R-studio and STATA software. Furthermore, the aforementioned study endpoints were stratified by the degree of left ventricular ejection fraction (LVEF) reduction into severe (<35%), moderate (<40%) and mild (<50%). Results Data from 25,031 HFrEF patients was analysed, out of which 12,957 (52%) underwent CABG and 12,074 (48%) received PCI. Long-term survival was significantly higher in the severe (<35%) and mildly (<50%) reduced LVEF groups, with no significant different found in the moderately (<40%) reduced LVEF cohort. However, all 3 groups significantly favoured CABG in terms of need for revascularization, but no difference in stroke incidence was found. As for postoperative MI, this followed the same trend as survival. No evidence of significant heterogeneity or publication bias was found. Conclusion CABG yields more favourable results than PCI in HFrEF patients. Further stratifying the clinical outcomes measured by the degree of LVEF reduction sheds light on the importance of risk stratification of patients to optimise results.