2024 年 15 巻 2 号 p. 79-87
Background: In patients with chronic heart failure and coronary artery disease (CAD) with residual myocardial viability, percutaneous coronary intervention (PCI) makes no difference in mortality and heart failure (HF) hospitalization compared with medical therapy. However, studies specifically focusing on the prognosis following PCI in patients hospitalized HF with concomitant CAD are limited.
Method and Results: A retrospective study of patients admitted for acute HF from April 1, 2017 to March 31, 2021 was conducted. Of a total of 649 patients who presented with acute decompensated HF, 92 had CAD with significant stenosis. A total of 60 patients were enrolled in the study, and the outcomes of the PCI group (n=28) and the medical therapy group (n=32) were compared. The primary endpoint was a composite of all-cause mortality, rehospitalization for HF, and acute coronary syndrome at one year. Clinical outcomes in the PCI and medical therapy groups were comparable, with no significant difference in the primary composite endpoint (log-rank test p=0.94). Chronic kidney disease (CKD) on admission was an independent predictor of clinical outcomes at one year (HR: 3.20, 95% CI: 1.12-9.16, p=0.03).
Conclusion: PCI did not improve clinical outcomes over medical therapy in patients hospitalized for HF with concomitant CAD. This study showed that, especially in patients with CKD, the cardiac team needs to address the precise clinical implications and prognostic benefits of the procedure in individual patients.
