The Present and Future
JACC State-of-the-Art Review
Impact of Percutaneous Coronary Intervention on Outcomes in Patients With Heart Failure: JACC State-of-the-Art Review

https://doi.org/10.1016/j.jacc.2021.03.310Get rights and content
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Highlights

  • Observational studies suggest a benefit of PCI in patients with HF.

  • Randomized data comparing outcomes of PCI, medical therapy, and surgical revascularization are lacking for patients with HF of various types.

  • Randomized studies comparing PCI with medical therapy and coronary bypass surgery should address both myocardial recovery and clinical outcomes.

Abstract

Coronary artery disease (CAD) is highly prevalent in patients with heart failure (HF) and accounts for nearly two-thirds of cases. The use of percutaneous coronary intervention (PCI) in HF patients with CAD has markedly increased and has been suggested to be associated with improved outcomes in numerous observational studies. Randomized data comparing the impact of PCI with that of coronary artery bypass graft (CABG) or contemporary guideline-directed medical therapy alone on clinical outcomes and myocardial recovery in patients with HF are lacking. The purpose of this review is to describe the available evidence regarding the impact of PCI in acute HF (in the presence and absence of an acute coronary syndrome), chronic HF with reduced ejection fraction, and HF with preserved ejection fraction. Adequately-powered randomized clinical trials examining the outcomes with PCI in these distinct HF populations are warranted.

Key Words

coronary artery disease
coronary revascularization
ejection fraction
heart failure
percutaneous coronary intervention

Abbreviations and Acronyms

ACS
acute coronary syndrome(s)
CABG
coronary artery bypass grafting
CAD
coronary artery disease
CTO
chronic total occlusion
HF
heart failure
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
LVEF
left ventricular ejection fraction
LVSD
left ventricular systolic dysfunction
PCI
percutaneous coronary intervention

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Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

Rhian Davies, DO, served as Guest Associate Editor for this paper. Athena Poppas, MD, served as Guest Editor-in-Chief for this paper.

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