Clinical Impact of Complete Revascularization Before Left Ventricular Assist Device Implantation in Patients With Severe Ischemic Cardiomyopathy.

BACKGROUND: Limited information exists regarding whether coronary revascularization by percutaneous coronary intervention (PCI) prior to left ventricular assist device (LVAD) implantation improves outcomes. This study aimed to investigate the clinical impact of complete revascularization (CR) by PCI before LVAD implantation in patients with severe ischemic cardiomyopathy (ICM). METHODS: From July 2013 to August 2024, data were retrospectively collected from all patients who underwent LVAD implantation at two tertiary referral hospitals. ICM patients were selected, and those who did not undergo coronary evaluation before LVAD implantation or who received a coronary artery bypass graft within one year were excluded from the analysis. Primary outcome was all-cause mortality at 2 years following LVAD implantation according to CR status. RESULTS: Among the 118 patients included in the study, 42 (35.6%) patients underwent CR by PCI within 1 year before LVAD implantation. All-cause death occurred in 18.3% of the patients in the CR group and 22.8% in the incomplete revascularization group (hazard ratio, 0.76; 95% confidence interval, 0.31-1.86; p = 0.554). There was also no significant difference in hospitalization for heart failure, ventricular arrhythmias, progressive right ventricular failure, or heart transplantation between patients in the CR group and those in the incomplete revascularization group. No acute coronary syndrome occurred during LVAD support regardless of CR status. CONCLUSION: CR by PCI before LVAD implantation in patients with severe ICM did not improve clinical outcomes following LVAD therapy. These findings suggest that revascularization should be carefully considered on a case-by-case basis, weighing potential risks and benefits.