Objective. The study aimed to compare the clinical outcomes between the patients receiving coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the patients with symptomatic severe left ventricular (LV) dysfunction and coronary artery disease (CAD). Methods. Between February 2007 and February 2020, a total of 745 patients who received coronary artery angiography for reduced LV ejection fraction (LVEF) < 40% and symptomatic New York Heart Association (NYHA) functional class ≥ 3 were recruited. The patients (N = 236) who were diagnosed with dilated cardiomyopathy or valvular heart disease without coronary artery stenosis, those with prior history of CABG or valvular surgery (N = 59), those who presented ST-segment elevated myocardial infarction (STEMI), those with a CAD and SYNTAX score of ≦ 22 (N = 175), those who received emergent CABG for coronary perforation (N = 3), and those who had NYHA class ≦ 2 (N = 65) were excluded. Finally, 116 patients with reduced LVEF and those who had a SYNTAX score >22, who received CABG (N = 47) and PCI (N = 69), were recruited for this study.Results. There was no significant difference in the incidence values of in-hospital course and those of in-hospital mortality, acute kidney injury, and postprocedural hemodialysis. There was no significant difference in the 1-yearfollow-up of recurrent MI, revascularization, or stroke between the groups. The 1-year heart failure (HF) hospitalization rate was significantly lower in the CABG group than in all patients of the PCI group (13.2% vs. 33.3%; ); however, there was no significant difference in the same variable between the CABG group and the complete revascularization subgroup (13.2% vs. 28.2%; ). The revascularization index (RI) was significantly higher in the CABG group than in all patients of the PCI group or complete revascularization subgroup (0.93 ± 0.12 vs. 0.71 ± 0.25; ) and (0.93 ± 0.12 vs. 0.86 ± 0.13; ). The 3-year HF hospitalization rate was significantly lower in the CABG group than in all patients of the PCI group (16.2% vs. 42.2%; ); however, there was no difference in the same variable between the CABG group and the complete revascularization subgroup (16.2% vs. 35.1%; ). Conclusions. In patients with symptomatic (NYHA class ≥ 3) severe LV dysfunction and CAD, CABG brought less HF admission when compared to patients in the PCI group, but this did not differ when compared to the complete revascularization subgroup. Therefore, an extensive revascularization, achieved by CABG or PCI, is associated with a lower HF hospitalization rate during the 3-yearfollow-up period in such populations.

中文翻译：

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冠状动脉旁路移植术和经皮冠状动脉介入治疗之间完全血运重建对症状性严重左心室功能不全的影响

目标。该研究旨在比较接受冠状动脉搭桥手术 (CABG) 或经皮冠状动脉介入治疗 (PCI) 治疗有症状的严重左心室 (LV) 功能障碍和冠状动脉疾病 (CAD) 患者的临床结果。方法。在 2007 年 2 月至 2020 年 2 月期间，共招募了 745 名因左室射血分数 (LVEF) 降低 < 40% 且有症状的纽约心脏协会 (NYHA) 功能分级≥ 3 而接受冠状动脉造影的患者。 诊断为扩张型心肌病或心脏瓣膜病但无冠状动脉狭窄的患者（N =236），既往有CABG或瓣膜手术史的患者（ N = 59)、出现 ST 段抬高型心肌梗死 (STEMI) 的患者、CAD 和 SYNTAX 评分≤ 22 的患者 ( N  = 175)、因冠状动脉穿孔接受急诊 CABG 的患者 ( N  = 3) 以及NYHA 等级≤ 2 ( N  = 65) 的患者被排除在外。最后，本研究招募了 116 名 LVEF 降低的患者和 SYNTAX 评分 >22 的患者，他们接受了 CABG (N = 47) 和 PCI (N = 69)。结果. 住院病程的发生率值与住院死亡率、急性肾损伤和术后血液透析的发生率值无显着差异。两组间 1 年的复发性 MI、血运重建或卒中随访无显着差异。CABG 组的 1 年心力衰竭 (HF) 住院率显着低于 PCI 组的所有患者（13.2% 对 33.3%；); 然而，CABG 组和完全血运重建亚组之间的同一变量没有显着差异（13.2% 对 28.2%；). CABG 组的血运重建指数 (RI) 显着高于 PCI 组或完全血运重建亚组的所有患者（0.93 ± 0.12 对 0.71 ± 0.25；)和 (0.93 ± 0.12 对比 0.86 ± 0.13;). CABG 组的 3 年 HF 住院率显着低于 PCI 组的所有患者（16.2% 对 42.2%；); 然而，CABG 组和完全血运重建亚组之间的相同变量没有差异（16.2% 对 35.1%；). 结论。在有症状（NYHA ≥ 3 级）严重左室功能不全和 CAD 的患者中，与 PCI 组患者相比，CABG 带来的心衰入院率较低，但这与完全血运重建亚组相比没有差异。因此，在这些人群中，通过 CABG 或 PCI 实现的广泛血运重建与 3 年随访期间较低的 HF 住院率相关。