Complete percutaneous revascularisation feasibility in ischaemic heart failure is related to improved outcomes: insights from the COMMIT-HF registry

Abstract

Background and aim: Heart failure (HF) is a major cause of death in cardiovascular disease. In a post-STICH landscape, we lack data on the role of percutaneous coronary intervention (PCI) in systolic HF patients. Complete revascularisation remains a key unanswered question in ischaemic HF.

Methods: The COMMIT-HF is an ongoing systolic HF registry (inclusion criteria: HF with left ventricular ejection fraction ≤ 35%, exclusion: acute coronary syndrome). A total of 1798 patients were enrolled. A group of patients with multi-vessel coronary artery disease qualified for PCI were selected and divided into complete (n = 188) and incomplete revascularisation (n = 159) groups. Completeness of revascularisation was defined as successful PCI of every angiographically significant lesion in all arteries with a diameter of ≥ 2 mm without a patent surgical graft. Patients were followed up for a period of at least 12 months with all-cause mortality defined as the primary endpoint.

Results: The study groups showed no significant differences in clinical status and echocardiographic parameters, with a lower comorbidity rate in the complete revascularisation group. Procedural characteristics were comparable. There were no significant differences in complication rates. All-cause mortality was significantly lower in the complete revascularisation group after 12-months (6.4% vs. 20.1%, p < 0.001). Multivariate analysis confirmed that achievement of complete revascularisation was an independent factor improving survival (HR 0.39; 95% CI 0.18–0.81, p = 0.01).

Conclusions: Percutaneous coronary intervention can be a safe and feasible method of revascularisation in ischaemic HF. Achievement of complete revascularisation with PCI was related to improved outcomes in the analysed patient population.