Optimizing Strategy of Coronary Revascularization in Patients With Multivessel Lesions Combined Heart Failure
Optimizing Strategy of Coronary Revascularization in Patients With Multivessel Lesions Combined Heart Failure
As the end stage of almost all cardiovascular diseases, heart failure has become an
 increasingly common cause of cardiovascular morbidity and mortality worldwide. In China,
 coronary artery disease (CAD) has become the main cause of heart failure in recent years. CAD
 combining with heart failure usually predicts poor outcome, with coronary revascularization
 the most universally used therapy. However, the difference of several types of such therapy
 has less well been compared.

 Thus, the study mainly aims to compare different types of coronary revascularization
 therapies such as Percutaneous Coronary Intervention (PCI),Coronary Artery Bypass Grafting
 (CABG) as well as Hybrid Coronary Revascularization (HCR), and also make the optimization
 strategy especially in patients with heart failure.

 The study also aims to investigate whether disease progression in patients with chronic heart
 failure (CHF) can be assessed by new biomarkers and determine their diagnostic and prognostic
 value, relating several cardiac functional parameters to clinical outcome.
STUDY DESIGN This is a single center prospective study mainly designed to compare different
 types of coronary revascularization therapies in patients with severe coronary artery disease
 combining heart failure. We will collect the data at baseline before the therapy, as well as
 30 days, 6 months and 12 months after surgery. Using follow-up visits along with effective
 exams such as echocardiography, cardiopulmonary function mensuration and tests of serum
 markers, we will principally make a comparison of both primary and secondary outcomes, also
 quality of life among patients in these three groups.

 STUDY POPULATION About 525 patients who are diagnosed with severe CAD and HF will be
 enrolled. Severe CAD is defined as at least 2 vessel disease with each ≥50% narrowing of the
 luminal diameter shown by coronary angiography, including LAD. Those enrolled also has
 reduced cardiac systolic function (LVEF≤50%).

 STUDY DURATION It will take about 2 years to finish all follow-up visits with each patient at
 least 12 months after surgery.

 STUDY PROCESS The statistical analysis will include all the materials of each patient in
 every follow-up visit. We will describe basic characteristics and test parameters of every
 visit, comparing those in PCI, CABG and HCR group, to further investigate the prognostic
 influence of each therapeutic method.

 Data analysis will be processed by SPSS. All the analysis will be used by the 2-side test
 with 95% confidence interval, showing statistical significance if 2-side p value is less than
 0.05. The study will finally report primary and secondary outcomes, as well as changes of
 several important parameters.
Inclusion Criteria:

 -  Age ≥18 years

 -  with at least 2 lesion vessels defined as ≥50% narrowing of the luminal diameter as
 shown by coronary angiography, including LAD

 -  LVEF≤50% as shown in echocardiography

 Exclusion Criteria:

 -  with other severe diseases combined and will be alive for less than 12 months

 -  combining valvular heart disease

 -  pregnant or lactating women

 -  during the acute phase of ST-elevation acute myocardial infarction

 -  with severe renal dysfunction requiring dialysis to cure

 -  hard to participate in the investigation or accept the follow-up visits

 -  those who have already taken PCI treatment before

 -  with other diseases which need to be treated by surgery