Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: Insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

Sebastian Völz; Björn Redfors; Oskar Angerås; Dan Ioanes; Jacob Odenstedt; Sasha Koul; Inger Valeljung; Christian Dworeck; Robin Hofmann; Emma Hansson; Dimitrios Venetsanos; Anders Ulvenstam; Tomas Jernberg; Truls Råmunddal; Pétur Pétursson; Ole Fröbert; David Erlinge; Anders Jeppsson; Elmir Omerovic

doi:10.1093/eurheartj/ehab273

Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: Insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

Sebastian Völz, Björn Redfors, Oskar Angerås, Dan Ioanes, Jacob Odenstedt, Sasha Koul, Inger Valeljung, Christian Dworeck, Robin Hofmann, Emma Hansson, Dimitrios Venetsanos, Anders Ulvenstam, Tomas Jernberg, Truls Råmunddal, Pétur Pétursson, Ole Fröbert, David Erlinge, Anders Jeppsson, Elmir Omerovic^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

42 Citations (Scopus)

Abstract

Aims: To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of patients with heart failure due to ischaemic heart disease. Methods and results: We analysed all-cause mortality following CABG or PCI in patients with heart failure with reduced ejection fraction and multivessel disease (coronary artery stenosis >50% in ≥2 vessels or left main) who underwent coronary angiography between 2000 and 2018 in Sweden. We used a propensity score-adjusted logistic and Cox proportional-hazards regressions and instrumental variable model to adjust for known and unknown confounders. Multilevel modelling was used to adjust for the clustering of observations in a hierarchical database. In total, 2509 patients (82.9% men) were included; 35.8% had diabetes and 34.7% had a previous myocardial infarction. The mean age was 68.1 ± 9.4 years (47.8% were >70 years old), and 64.9% had three-vessel or left main disease. Primary designated therapy was PCI in 56.2% and CABG in 43.8%. Median follow-up time was 3.9 years (range 1 day to 10 years). There were 1010 deaths. Risk of death was lower after CABG than after PCI [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.41-0.96; P = 0.031]. The risk of death increased linearly with quintiles of hospitals in which PCI was the preferred method for revascularization (OR 1.27, 95% CI 1.17-1.38, Ptrend < 0.001). Conclusion: In patients with ischaemic heart failure, long-term survival was greater after CABG than after PCI.

Original language	English
Journal	European Heart Journal
Volume	42
Issue	27
Pages (from-to)	2657-2664
Number of pages	8
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehab273
Publication status	Published - 14 Jul 2021
Externally published	Yes

Keywords

Coronary artery bypass grafting
Coronary artery disease
Diabetes mellitus
Heart failure
Percutaneous coronary intervention

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10.1093/eurheartj/ehab273

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Völz, S., Redfors, B., Angerås, O., Ioanes, D., Odenstedt, J., Koul, S., Valeljung, I., Dworeck, C., Hofmann, R., Hansson, E., Venetsanos, D., Ulvenstam, A., Jernberg, T., Råmunddal, T., Pétursson, P., Fröbert, O., Erlinge, D., Jeppsson, A., & Omerovic, E. (2021). Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: Insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). European Heart Journal, 42(27), 2657-2664. https://doi.org/10.1093/eurheartj/ehab273

@article{4afeeb263ee342bb982e85159e99f628,

title = "Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: Insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)",

abstract = "Aims: To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of patients with heart failure due to ischaemic heart disease. Methods and results: We analysed all-cause mortality following CABG or PCI in patients with heart failure with reduced ejection fraction and multivessel disease (coronary artery stenosis >50% in ≥2 vessels or left main) who underwent coronary angiography between 2000 and 2018 in Sweden. We used a propensity score-adjusted logistic and Cox proportional-hazards regressions and instrumental variable model to adjust for known and unknown confounders. Multilevel modelling was used to adjust for the clustering of observations in a hierarchical database. In total, 2509 patients (82.9% men) were included; 35.8% had diabetes and 34.7% had a previous myocardial infarction. The mean age was 68.1 ± 9.4 years (47.8% were >70 years old), and 64.9% had three-vessel or left main disease. Primary designated therapy was PCI in 56.2% and CABG in 43.8%. Median follow-up time was 3.9 years (range 1 day to 10 years). There were 1010 deaths. Risk of death was lower after CABG than after PCI [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.41-0.96; P = 0.031]. The risk of death increased linearly with quintiles of hospitals in which PCI was the preferred method for revascularization (OR 1.27, 95% CI 1.17-1.38, Ptrend < 0.001). Conclusion: In patients with ischaemic heart failure, long-term survival was greater after CABG than after PCI.",

keywords = "Coronary artery bypass grafting, Coronary artery disease, Diabetes mellitus, Heart failure, Percutaneous coronary intervention",

author = "Sebastian V{\"o}lz and Bj{\"o}rn Redfors and Oskar Anger{\aa}s and Dan Ioanes and Jacob Odenstedt and Sasha Koul and Inger Valeljung and Christian Dworeck and Robin Hofmann and Emma Hansson and Dimitrios Venetsanos and Anders Ulvenstam and Tomas Jernberg and Truls R{\aa}munddal and P{\'e}tur P{\'e}tursson and Ole Fr{\"o}bert and David Erlinge and Anders Jeppsson and Elmir Omerovic",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2021",

month = jul,

day = "14",

doi = "10.1093/eurheartj/ehab273",

language = "English",

volume = "42",

pages = "2657--2664",

journal = "European Heart Journal",

issn = "0195-668X",

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number = "27",

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Völz, S, Redfors, B, Angerås, O, Ioanes, D, Odenstedt, J, Koul, S, Valeljung, I, Dworeck, C, Hofmann, R, Hansson, E, Venetsanos, D, Ulvenstam, A, Jernberg, T, Råmunddal, T, Pétursson, P, Fröbert, O, Erlinge, D, Jeppsson, A & Omerovic, E 2021, 'Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: Insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)', European Heart Journal, vol. 42, no. 27, pp. 2657-2664. https://doi.org/10.1093/eurheartj/ehab273

Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: Insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). / Völz, Sebastian; Redfors, Björn; Angerås, Oskar et al.
In: European Heart Journal, Vol. 42, No. 27, 14.07.2021, p. 2657-2664.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention

T2 - Insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

AU - Völz, Sebastian

AU - Redfors, Björn

AU - Angerås, Oskar

AU - Ioanes, Dan

AU - Odenstedt, Jacob

AU - Koul, Sasha

AU - Valeljung, Inger

AU - Dworeck, Christian

AU - Hofmann, Robin

AU - Hansson, Emma

AU - Venetsanos, Dimitrios

AU - Ulvenstam, Anders

AU - Jernberg, Tomas

AU - Råmunddal, Truls

AU - Pétursson, Pétur

AU - Fröbert, Ole

AU - Erlinge, David

AU - Jeppsson, Anders

AU - Omerovic, Elmir

PY - 2021/7/14

Y1 - 2021/7/14

N2 - Aims: To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of patients with heart failure due to ischaemic heart disease. Methods and results: We analysed all-cause mortality following CABG or PCI in patients with heart failure with reduced ejection fraction and multivessel disease (coronary artery stenosis >50% in ≥2 vessels or left main) who underwent coronary angiography between 2000 and 2018 in Sweden. We used a propensity score-adjusted logistic and Cox proportional-hazards regressions and instrumental variable model to adjust for known and unknown confounders. Multilevel modelling was used to adjust for the clustering of observations in a hierarchical database. In total, 2509 patients (82.9% men) were included; 35.8% had diabetes and 34.7% had a previous myocardial infarction. The mean age was 68.1 ± 9.4 years (47.8% were >70 years old), and 64.9% had three-vessel or left main disease. Primary designated therapy was PCI in 56.2% and CABG in 43.8%. Median follow-up time was 3.9 years (range 1 day to 10 years). There were 1010 deaths. Risk of death was lower after CABG than after PCI [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.41-0.96; P = 0.031]. The risk of death increased linearly with quintiles of hospitals in which PCI was the preferred method for revascularization (OR 1.27, 95% CI 1.17-1.38, Ptrend < 0.001). Conclusion: In patients with ischaemic heart failure, long-term survival was greater after CABG than after PCI.

AB - Aims: To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of patients with heart failure due to ischaemic heart disease. Methods and results: We analysed all-cause mortality following CABG or PCI in patients with heart failure with reduced ejection fraction and multivessel disease (coronary artery stenosis >50% in ≥2 vessels or left main) who underwent coronary angiography between 2000 and 2018 in Sweden. We used a propensity score-adjusted logistic and Cox proportional-hazards regressions and instrumental variable model to adjust for known and unknown confounders. Multilevel modelling was used to adjust for the clustering of observations in a hierarchical database. In total, 2509 patients (82.9% men) were included; 35.8% had diabetes and 34.7% had a previous myocardial infarction. The mean age was 68.1 ± 9.4 years (47.8% were >70 years old), and 64.9% had three-vessel or left main disease. Primary designated therapy was PCI in 56.2% and CABG in 43.8%. Median follow-up time was 3.9 years (range 1 day to 10 years). There were 1010 deaths. Risk of death was lower after CABG than after PCI [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.41-0.96; P = 0.031]. The risk of death increased linearly with quintiles of hospitals in which PCI was the preferred method for revascularization (OR 1.27, 95% CI 1.17-1.38, Ptrend < 0.001). Conclusion: In patients with ischaemic heart failure, long-term survival was greater after CABG than after PCI.

KW - Coronary artery bypass grafting

KW - Coronary artery disease

KW - Diabetes mellitus

KW - Heart failure

KW - Percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85112125166&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehab273

DO - 10.1093/eurheartj/ehab273

M3 - Journal article

C2 - 34023903

AN - SCOPUS:85112125166

SN - 0195-668X

VL - 42

SP - 2657

EP - 2664

JO - European Heart Journal

JF - European Heart Journal

IS - 27

ER -

Völz S, Redfors B, Angerås O, Ioanes D, Odenstedt J, Koul S et al. Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: Insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). European Heart Journal. 2021 Jul 14;42(27):2657-2664. doi: 10.1093/eurheartj/ehab273

Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: Insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

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