{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T07:21:55Z","timestamp":1782631315963,"version":"3.54.5"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T00:00:00Z","timestamp":1663286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: We compared the outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) for revascularization in patients with reduced ejection fraction (EF) and severe coronary artery disease (CAD). Methods: Between February 2006 and February 2020, a total of 797 patients received coronary angiograms due to left ventricular EF \u2264 40% at our hospital. After excluding diagnoses of dilated cardiomyopathy, valvular heart disease, prior CABG, acute ST-segment myocardial infarction, and CAD with low Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score (\u226422), 181 patients with severe coronary artery disease (CAD) with SYNTAX score &gt;22 underwent CABG or PCI for revascularization. Vascular characteristics as well as echocardiographic data were compared between CABG (n = 58) and PCI (n = 123) groups. Results: A younger age (62 \u00b1 9.0 vs. 66 \u00b1 12.1; p = 0.016), higher new EuroSCORE II (8.6 \u00b1 7.3 vs. 3.2 \u00b1 2.0; p &lt; 0.001), and higher SYNTAX score (40.5 \u00b1 9.8 vs. 35.4 \u00b1 8.3; p &lt; 0.001) were noted in the CABG group compared to those in the PCI group. The CABG group had a significantly higher cardiovascular mortality rate at 1-year (19.6% vs. 5.0%, p = 0.005) and 3-year (25.0% vs. 11.4%, p = 0.027) follow-ups but a lower incidence of heart failure (HF) hospitalization at 1-year (11.1% vs. 28.2%, p = 0.023) and 3-year (3.6% vs. 42.5%, p = 0.001) follow-ups compared to those of the PCI group. Conclusions: Compared with PCI, revascularization with CABG was related to a lower incidence of HF hospitalization but a worse survival outcome in patients with severe CAD and reduced EF. CABG-associated reduction in HF hospitalization was more notable when SYNTAX score \u226533.<\/jats:p>","DOI":"10.3390\/diagnostics12092233","type":"journal-article","created":{"date-parts":[[2022,9,18]],"date-time":"2022-09-18T22:12:43Z","timestamp":1663539163000},"page":"2233","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Coronary Artery Bypass Graft Surgery Brings Better Benefits to Heart Failure Hospitalization for Patients with Severe Coronary Artery Disease and Reduced Ejection Fraction"],"prefix":"10.3390","volume":"12","author":[{"given":"Yu-Wen","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0585-6134","authenticated-orcid":false,"given":"Wei-Chieh","family":"Lee","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan"},{"name":"Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan"},{"name":"Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiu-Yu","family":"Fang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2524-9684","authenticated-orcid":false,"given":"Cheuk-Kwan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, E-Da Hospital, Kaohsiung 83301, Taiwan"},{"name":"School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiunn-Jye","family":"Sheu","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,16]]},"reference":[{"key":"ref_1","first-page":"e9349","article-title":"Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study","volume":"12","author":"Khan","year":"2020","journal-title":"Cureus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e003255","DOI":"10.1161\/CIRCHEARTFAILURE.116.003255","article-title":"Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients with Reduced Ejection Fraction and Coronary Artery Disease: A Meta-Analysis","volume":"10","author":"Wolff","year":"2017","journal-title":"Circ. Heart Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"g3859","DOI":"10.1136\/bmj.g3859","article-title":"Revascularisation versus medical treatment in patients with stable coronary artery disease: Network meta-analysis","volume":"348","author":"Windecker","year":"2014","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1001\/jama.2020.10262","article-title":"Heart Failure with Reduced Ejection Fraction: A Review","volume":"324","author":"Murphy","year":"2020","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1056\/NEJMoa1409077","article-title":"Angiotensin-neprilysin inhibition versus enalapril in heart failure","volume":"371","author":"Mcmurray","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2476","DOI":"10.1016\/j.jacc.2017.08.074","article-title":"Heart Failure with Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes","volume":"70","author":"Shah","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"17058","DOI":"10.1038\/nrdp.2017.58","article-title":"Heart failure with reduced ejection fraction","volume":"3","author":"Bloom","year":"2017","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1001\/jamacardio.2020.0239","article-title":"Long-term Outcomes in Patients with Severely Reduced Left Ventricular Ejection Fraction Undergoing Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting","volume":"5","author":"Sun","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/S0140-6736(18)30423-9","article-title":"Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: A pooled analysis of individual patient data","volume":"391","author":"Head","year":"2018","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1002\/ejhf.1681","article-title":"Impact of left ventricular ejection fraction on clinical outcomes after left main coronary artery revascularization: Results from the randomized EXCEL trial","volume":"22","author":"Thuijs","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1093\/ehjqcco\/qcx008","article-title":"Percutaneous coronary intervention vs. coronary artery bypass grafting for left main revascularization: An updated meta-analysis","volume":"3","author":"Bajaj","year":"2017","journal-title":"Eur. Heart J. Qual. Care Clin. Outcomes"},{"key":"ref_13","first-page":"100083","article-title":"Cardiac ultrasound: An Anatomical and Clinical Review","volume":"22","author":"Aly","year":"2021","journal-title":"Transl. Res. Anat."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Balakrishnan, S., and Kumar, B.S. (2021). Factors causing variability in formation of coronary collaterals during coronary artery disease. Folia Morphol.","DOI":"10.5603\/FM.a2021.0110"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"584","DOI":"10.5603\/FM.a2021.0084","article-title":"Morphologic comparison of blood vessels used for coronary artery bypass graft surgery","volume":"81","author":"Garnizone","year":"2022","journal-title":"Folia Morphol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"51","DOI":"10.5603\/FM.2014.0007","article-title":"Prevalence of congenital coronary artery anomalies and variants in 726 consecutive patients based on 64-slice coronary computed tomography angiography","volume":"73","author":"Szymczyk","year":"2014","journal-title":"Folia Morphol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.amjcard.2014.07.007","article-title":"Comparison of five-year outcomes of coronary artery bypass grafting versus percutaneous coronary intervention in patients with left ventricular ejection fractions \u226450% versus >50% (from the CREDO-Kyoto PCI\/CABG Registry Cohort-2)","volume":"114","author":"Marui","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"506","DOI":"10.21037\/acs.2018.05.17","article-title":"Coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in the treatment of multivessel coronary disease: Quo vadis?\u2014A review of the evidences on coronary artery disease","volume":"7","author":"Spadaccio","year":"2018","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.carrev.2020.08.040","article-title":"Intermediate and Late Outcomes with PCI vs CABG for Left Main Disease\u2014Landmark Meta-Analysis of Randomized Trials","volume":"23","author":"Akintoye","year":"2021","journal-title":"Cardiovasc. Revasc. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1002\/ehf2.13141","article-title":"Short-term and long-term outcomes of revascularization interventions for patients with severely reduced left ventricular ejection fraction: A meta-analysis","volume":"8","author":"Pei","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1056\/NEJMoa1406656","article-title":"Demographic and epidemiologic drivers of global cardiovascular mortality","volume":"372","author":"Roth","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.1016\/j.jacc.2013.05.019","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines","volume":"62","author":"Yancy","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1111\/joic.12497","article-title":"Comparison of three treatment strategies for patients with triple-vessel coronary disease and left ventricular dysfunction","volume":"31","author":"Jiang","year":"2018","journal-title":"J. Interv. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1056\/NEJMoa0804626","article-title":"Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease","volume":"360","author":"Serruys","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1161\/CIRCULATIONAHA.120.050749","article-title":"Effect of Adding Ticagrelor to Standard Aspirin on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting (POPular CABG): A Randomized, Double-Blind, Placebo-Controlled Trial","volume":"142","author":"Willemsen","year":"2020","journal-title":"Circulation"},{"key":"ref_26","first-page":"85","article-title":"Comparison of survival rate and complications of percutaneous coronary intervention, coronary artery bypass graft, and medical treatment in patients with left main and\/or three vessel diseases","volume":"16","author":"Khosravi","year":"2020","journal-title":"ARYA Atheroscler."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S0140-6736(19)32972-1","article-title":"Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: Updated 5-year outcomes from the randomised, non-inferiority NOBLE trial","volume":"395","author":"Holm","year":"2020","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1001\/jamacardio.2017.2895","article-title":"Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients with Left Main Coronary Artery Stenosis: A Systematic Review and Meta-analysis","volume":"2","author":"Giacoppo","year":"2017","journal-title":"JAMA Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1093\/ejcts\/ezu131","article-title":"Three-year outcomes after percutaneous coronary intervention and coronary artery bypass grafting in patients with heart failure: From the CREDO-Kyoto percutaneous coronary intervention\/coronary artery bypass graft registry cohort-2","volume":"47","author":"Marui","year":"2015","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.jacc.2007.10.030","article-title":"Localized elevation of shear stress is related to coronary plaque rupture: A 3-dimensional intravascular ultrasound study with in-vivo color mapping of shear stress distribution","volume":"51","author":"Fukumoto","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"025006","DOI":"10.1088\/2057-1976\/aa9a09","article-title":"Estimating current and long-term risks of coronary artery in silico by fractional flow reserve, wall shear stress and low-density lipoprotein filtration rate","volume":"4","author":"Liu","year":"2018","journal-title":"Biomed. Phys. Eng. Express"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1161\/CIRCRESAHA.114.302721","article-title":"Mechanisms of plaque formation and rupture","volume":"114","author":"Bentzon","year":"2014","journal-title":"Circ. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1631\/jzus.B2100425","article-title":"Index of microcirculatory resistance: State-of-the-art and potential applications in computational simulation of coronary artery disease","volume":"23","author":"Geng","year":"2022","journal-title":"J. Zhejiang Univ. Sci. B"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3574","DOI":"10.3889\/oamjms.2019.849","article-title":"Changes of Left Ventricular Systolic Function in Patients Undergoing Coronary Artery Bypass Grafting","volume":"7","author":"Papestiev","year":"2019","journal-title":"Open Access Maced. J. Med. Sci."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/9\/2233\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:32:42Z","timestamp":1760142762000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/9\/2233"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,16]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["diagnostics12092233"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12092233","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,16]]}}}