Improvement of percutaneous coronary intervention in patients with ischemic cardiomyopathy: a systematic literature review
Abstract
Aim. To evaluate the effectiveness of percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy and identify opportunities for its improvement, as well as to conduct a comparative analysis with coronary artery bypass grafting (CABG).
Materials and methods. A systematic search of medical literature published from 2017 to 2025 was conducted using PubMed, Scopus, Web of Science, and Google Scholar databases. 110 sources from high-impact factor journals were analyzed, including key randomized controlled trials (STICH, REVIVED-BCIS2), meta-analyses, and systematic reviews on ischemic cardiomyopathy and revascularization methods.
Results. Ischemic cardiomyopathy is the leading global cause of heart failure, in the treatment of which revascularization plays an important role alongside quadruple pharmacotherapy. PCI demonstrates superior stroke risk reduction compared to CABG, while CABG excels in reducing repeat revascularization needs and improving long-term survival. In patients achieving complete revascularization, mortality risk decreased by 34% and repeat revascularization risk by 33%.
Conclusion. When choosing between PCI and CABG in patients with ischemic cardiomyopathy, patient clinical characteristics, coronary anatomy, and comorbidities must be considered. The degree of revascularization and myocardial viability are important factors determining clinical outcomes.
About the Authors
List of references
Roth GA, Mensah GA, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology.2020; 76(25): 2982-3021. https://doi.org/10.1016/j.jacc.2020.11.010.
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021; 42(36): 3599-3726. https://doi.org/10.1093/ eurheartj/ehab368.
McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Ponikowski, P. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2023; 44(37): 3627-3739. https://doi.org/10.1093/eurheartj/ehad195.
Cabac-Pogorevici I., Muk B., Rustamova Y., et al. Ischaemic cardiomyopathy: Pathophysiological insights, diagnostic management and the roles of revascularisation and device treatment. European Journal of Heart Failure. 2020; 22: 789-799. https://doi.org/10.1002/ejhf.1747.
Albakri A. Ischemic cardiomyopathy: A review of literature on clinical status and meta-analysis of diagnostic and clinical management. Biology, Engineering and Medicine. 2018; 3(5): 1-13. https://doi.org/10.15761/BEM.1000151.
McDonagh T.A., Metra M., Adamo M., et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021; 42: 3599-3726. https://doi.org/10.1093/ eurheartj/ehab368.
Roth G.A., Mensah G.A., Johnson C.O., et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology. 2020; 76: 2982-3021. https://doi.org/10.1016/j.jacc.2020.11.010.
Tsao C.W., Aday A.W., Almarzooq Z.I., et al. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation. 2022; 145: e153-e639. https://doi.org/10.1161/CIR. 0000000000001052.
Khan M.A.B., Hashim M.J., Mustafa H., et al. Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study. Cureus. 2020; 12(7): e9349. https://doi.org/10.7759/cureus.93 49.
Khan M., Hashim M.J., Mustafa H., et al. Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study. Cureus. 2020; 12(7): e9349. https://doi.org/10.7759/cureus.9349.
Goh RSJ, Chong B, Jayabaskaran J, et al. The burden of cardiovascular disease in Asia from 2025 to 2050: a forecast analysis for East Asia, South Asia, South-East Asia, Central Asia, and high-income Asia Pacific regions. The Lancet Regional Health - Western Pacific. 2024; 49: 101138. https://doi.org/10.101 6/j.lanwpc.2024.101138.
Masenga SK, Kirabo A. Hypertensive heart disease: risk factors, complications and mechanisms. Frontiers in Cardiovascular Medicine. 2023; 10: 1205475. doi.org/10.3389/fcvm.2023.1205475.
Murphy SP, Kakkar R, McCarthy CP, Januzzi JL. Inflammation in Heart Failure. J Am Coll Cardiol. 2020; 75: 1324-40. https://doi.org/10.1016/j.jacc.2020.01.014.
Cappannoli L, Galli M, Borovac JA, Valeriani E, Animati FM, Fracassi F, Burzotta F. Editorial: Inflammation in ischemic heart disease: pathophysiology, biomarkers, and therapeutic implications. Frontiers in Cardiovascular Medicine. 2024; 11: 1469413. https://doi.org/10.3389/fcvm.2024.1469413.
Reina-Couto M, Pereira-Terra P, Quelhas-Santos J, Silva-Pereira C, Albino-Teixeira A, Sousa T. Inflammation in Human Heart Failure: Major Mediators and Therapeutic Targets. Frontiers in Physiology. 2021; 12: 746494. https://doi.org/10.3389/fphys.2021.746494.
Yan, B.W., Spahillari, A., Pandya, A. Cost-Effectiveness of Quadruple Therapy in Management of Heart Failure With Reduced Ejection Fraction in the United States. Circulation: Cardiovascular Quality and Outcomes. 2023; 16(6): e009793. https://doi.org/10.1161/CIRCOUTCOMES.122.009793.
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021; 42(36): 3599-3726. https://doi.org/10.1093/eurheartj/ehab368.
Alzahrani A.H., Alabbadi S., Itagaki S., Egorova N. Temporal Trend in Revascularization for Patients With Ischemic Cardiomyopathy and Multivessel Coronary Artery Disease. Journal of the American Heart Association. 2024; 13: e032212. https://doi.org/10.1161/JAHA.123.032212.
Girotra S, Kumbhani DJ. Percutaneous Coronary Intervention for Heart Failure: Worth the Cost? Circulation: Cardiovascular Quality and Outcomes. 2024; 17: e010572. https://doi.org/10.1161/ CIRCOUTCOMES.123.010572.
Alzahrani A.H., Alabbadi S., Itagaki S., Egorova N. Temporal Trend in Revascularization for Patients With Ischemic Cardiomyopathy and Multivessel Coronary Artery Disease. Journal of the American Heart Association. 2024; 13: e032212. https://doi.org/10.1161/JAHA.123.032212.
Carlos Chivardi, Holly Morgan, Mark J. Sculpher, Tim Clayton, Richard Evans, Matthew Dodd, Mark Petrie, Christopher A. Rinaldi, Peter O’Kane, Louise Brown, Divaka Perera, Pedro Saramago. Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction: Cost-Effectiveness Analysis of the REVIVED-BCIS2 Trial. Circulation: Cardiovascular Quality and Outcomes. 2024; 17: e010533. https://doi.org/10.1161/CIRCOUTCOMES.123.010533.
Bloom JE, Vogrin S, Reid CM et al. Coronary artery bypass grafting vs. percutaneous coronary intervention in severe ischaemic cardiomyopathy: long-term survival. European Heart Journal. 2025; 46: 72-80. https://doi.org/10.1093/eurheartj/ehae672.
Kirov H, Caldonazo T, Riedel LL, et al. Comparing outcomes between coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with left main or multivessel disease. Scientific Reports. 2023; 13: 22323. https://doi.org/10.1038/s41598-023-49069-2.
Llerena-Velastegui J, Zumbana-Podaneva K, Velastegui-Zurita S, et al. Comparative Efficacy of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in the Treatment of Ischemic Heart Disease: A Systematic Review and Meta-Analysis of Recent Randomized Controlled Trials. Cardiol Res. 2024; 15(3): 153-168. https://doi.org/10.14740/cr1638.
Llerena-Velastegui J, Zumbana-Podaneva K, Velastegui-Zurita S, et al. Comparative Efficacy of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in the Treatment of Ischemic Heart Disease: A Systematic Review and Meta-Analysis of Recent Randomized Controlled Trials. Cardiol Res. 2024; 15(3): 153-168. https://doi.org/10.14740/cr1638.
Kirov H, Caldonazo T, Riedel LL, et al. Comparing outcomes between coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with left main or multivessel disease. Scientific Reports. 2023; 13: 22323. https://doi.org/10.1038/s41598-023-49069-2.
Meynet P, Improta R, Carbone ML, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in left main disease according to patients’ sex: A meta-analysis. Eur J Clin Invest. 2025; 55: e14348. https://doi.org/10.1111/eci.14348.
Meynet P, Improta R, Carbone ML, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in left main disease according to patients’ sex: A meta-analysis. Eur J Clin Invest. 2025; 55: e14348. https://doi.org/10.1111/eci.14348.
Gaba P, Sabik JF, Murphy SA, et al. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With and Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials. Circulation. 2024; 149: 1328-1338. https://doi.org/10.1161/ CIRCULATIONAHA.123.065571.
Ferrante G, Presbitero P, Valgimigli M, et al. Percutaneous coronary intervention versus bypass surgery for left main coronary artery disease: a meta-analysis of randomised trials. EuroIntervention. 2011; 7: 738-746. https://doi.org/10.4244/EIJV7I6A117.
Feng S, Li M, Fei J, Dong A, Zhang W, Fu Y, Zhao Y. Ten-year outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for multivessel or left main coronary artery disease: a systematic review and meta-analysis. Journal of Cardiothoracic Surgery. 2023; 18: 54. https://doi.org/10.1186/s13019-023-02101-y.
Lee SE, Lee HY, Cho HJ, et al. Coronary artery bypass graft versus percutaneous coronary intervention in acute heart failure. Heart. 2020; 106: 50-57. https://doi.org/10.1136/heartjnl-2018-313242.
Ezad SM, McEntegart M, Dodd M, et al. Impact of Anatomical and Viability-Guided Completeness of Revascularization on Clinical Outcomes in Ischemic Cardiomyopathy. Journal of the American College of Cardiology. 2024; 84(4): 340-350. https://doi.org/10.1016/j.jacc.2024.04.043.
Perera D, Ryan M, Morgan HP, Greenwood JP, Petrie MC, et al. Viability and Outcomes With Revascularization or Medical Therapy in Ischemic Ventricular Dysfunction A Prespecified Secondary Analysis of the REVIVED-BCIS2 Trial. JAMA Cardiology. 2023; 8(12): 1154-1161. https://doi.org/10.1 001/jamacardio.2023.3803.
Kim T.O., Kim S., Kim M.J., et al. Long-term impacts of complete revascularization on clinical outcomes in patients with coronary chronic total occlusion. Heliyon. 2024; 10: e40326. https://doi.org/10.1016/j. heliyon.2024.e40326.
Ezad SM, McEntegart M, Dodd M, et al. Impact of Anatomical and Viability-Guided Completeness of Revascularization on Clinical Outcomes in Ischemic Cardiomyopathy. Journal of the American College of Cardiology. 2024; 84(4): 340-350. https://doi.org/10.1016/j.jacc.2024.04.043.
Copyright (c) 2025 Х.Г. Фозилов, А.М. Абдукамилов (Автор)
This work is licensed under a Creative Commons Attribution 4.0 International License.