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Coronary revascularization for heart failure with coronary artery disease: A systematic review and meta-analysis of randomized trials.
Iaconelli, Antonio; Pellicori, Pierpaolo; Dolce, Pasquale; Busti, Matteo; Ruggio, Aureliano; Aspromonte, Nadia; D'Amario, Domenico; Galli, Mattia; Princi, Giuseppe; Caiazzo, Elisabetta; Rezig, Asma O M; Maffia, Pasquale; Pecorini, Giovanni; Crea, Filippo; Cleland, John G F.
Afiliação
  • Iaconelli A; School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
  • Pellicori P; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Dolce P; School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
  • Busti M; Department of Public Health, University of Naples Federico II, Naples, Italy.
  • Ruggio A; Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
  • Aspromonte N; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • D'Amario D; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Galli M; Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
  • Princi G; Division of Cardiology, Azienda Ospedaliero Universitaria 'Maggiore della Carità', Novara, Italy.
  • Caiazzo E; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
  • Rezig AOM; Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
  • Maffia P; Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.
  • Pecorini G; School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
  • Crea F; School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
  • Cleland JGF; Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Eur J Heart Fail ; 25(7): 1094-1104, 2023 07.
Article em En | MEDLINE | ID: mdl-37211964
AIMS: Coronary artery disease (CAD) is a common cause of heart failure (HF). Whether coronary revascularization improves outcomes in patients with HF receiving guideline-recommended pharmacological therapy (GRPT) remains uncertain; therefore, we conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs). METHODS AND RESULTS: We searched in public databases for RCTs published between 1 January 2001 and 22 November 2022, investigating the effects of coronary revascularization on morbidity and mortality in patients with chronic HF due to CAD. All-cause mortality was the primary outcome. We included five RCTs that enrolled, altogether, 2842 patients (most aged <65 years; 85% men; 67% with left ventricular ejection fraction ≤35%). Overall, compared to medical therapy alone, coronary revascularization was associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.79-0.99; p = 0.0278) and cardiovascular mortality (HR 0.80, 95% CI 0.70-0.93; p = 0.0024) but not the composite of hospitalization for HF or all-cause mortality (HR 0.87, 95% CI 0.74-1.01; p = 0.0728). There were insufficient data to show whether the effects of coronary artery bypass graft surgery or percutaneous coronary intervention were similar or differed. CONCLUSIONS: For patients with chronic HF and CAD enrolled in RCTs, the effect of coronary revascularization on all-cause mortality was statistically significant but neither substantial (HR 0.88) nor robust (upper 95% CI close to 1.0). RCTs were not blinded, which may bias reporting of the cause-specific reasons for hospitalization and mortality. Further trials are required to determine which patients with HF and CAD obtain a substantial benefit from coronary revascularization by either coronary artery bypass graft surgery or percutaneous coronary intervention.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Intervenção Coronária Percutânea / Insuficiência Cardíaca Tipo de estudo: Clinical_trials / Guideline / Systematic_reviews Limite: Female / Humans / Male Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Intervenção Coronária Percutânea / Insuficiência Cardíaca Tipo de estudo: Clinical_trials / Guideline / Systematic_reviews Limite: Female / Humans / Male Idioma: En Ano de publicação: 2023 Tipo de documento: Article