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Revascularization in ischaemic heart failure with preserved ejection fraction: a nationwide cohort study

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Salil V. Deo, Yogesh N.V. Reddy, Rosita Zakeri, Mohamad Karnib, Padmini Selvaganesan, Yakov Elgudin, Ahmet Kilic, Joseph Rubelowsky, Salah E. Altarabsheh, Mohammed N. Osman, Richard A. Josephson, Sri Krishna Madan Mohan, Brian Cmolik, Daniel I. Simon, Sanjay Rajagopalan, John G.F. Cleland, Jayakumar Sahadevan, Varun Sundaram

Original languageEnglish
Pages (from-to)1427-1438
Number of pages12
JournalEUROPEAN JOURNAL OF HEART FAILURE
Volume24
Issue number8
Early online date10 Mar 2022
DOIs
Accepted/In press31 Jan 2022
E-pub ahead of print10 Mar 2022
PublishedAug 2022

Bibliographical note

Publisher Copyright: © 2022 European Society of Cardiology.

King's Authors

Abstract

Aims: Despite the common occurrence of coronary artery disease (CAD) and heart failure (HF) with preserved ejection fraction (HFpEF), there is limited evidence to guide revascularization. Methods and Results: We investigated the long-term outcomes of coronary artery bypass grafting (CABG) in patients with HF and significant CAD across the spectrum of ejection fraction, using a large national cohort of patients from the Veteran Affairs (VA) Medical Centers in the US. Patients with HF were stratified into groups, HFpEF, HF with mid-range ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF) and compared to patients with no preoperative HF. We analysed 10 396 patients. Despite an increased hazard in the first year following revascularization, the long-term survival (median follow-up 6.6 years; interquartile range 3.7–10.1) of HFpEF post-CABG was similar to controls (hazard ratio 0.85, 95% confidence interval 0.68-1.06), but survival progressively declined with HFmrEF and HFrEF. Similar trends were seen with recurrent HF hospitalization with lower risk with baseline HFpEF (43.9 ± 6.9/100 patient-years) compared to HFmrEF (65.9 ± 3.8/100 patient-years) and HFrEF (93.4 ± 4.8/100 patient-years). Although HFpEF patients had lower mortality and HF hospitalization post-CABG compared to patients with a lower ejection fraction, they experienced the highest rates of future myocardial infarction. Conclusion: Although HFpEF patients with CAD have greater short-term risk post-CABG, their long-term survival is comparable to controls. However, they are at increased risk for HF hospitalizations and myocardial infarction. These data support the safety of CABG in HFpEF patients and suggest continuum of mortality risk for ischaemic HF when stratified by baseline ejection fraction before revascularization.

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