CRT and CABG Improve Survival and Reduce Readmissions in Ischemic Heart Failure: A Systematic Review and Meta-Analysis.

INTRODUCTION: Heart failure (HF) continues to be the leading cause of death and rehospitalization among cardiomyopathic patients undergoing coronary artery bypass grafting (CABG). OBJECTIVES: To systematically evaluate the effect of adding cardiac resynchronization therapy (CRT) to CABG versus CABG alone for patients with concomitant ischemic cardiomyopathy and electromechanical dyssynchrony. (PROSPERO ID: CRD420251006918) METHODS: A comprehensive literature search was conducted using PubMed, Web of Science, and Scopus to identify clinical trials and cohort studies evaluating the impact of inserting a CRT device during CABG surgery on survival and rehospitalization outcomes. A total of 3 studies involving 300 patients were included: 150 underwent CABG alone, and 150 received both CABG and CRT. RESULTS: The meta-analysis of two studies (n = 200) showed that adding CRT during CABG was associated with lowering the probability of HF readmission (RR = 0.25, 95% CI [0.13-0.49], P < 0.0001) and of all-cause mortality (RR = 0.44, 95% CI [0.25-0.78], p = 0.0048) in the targeted patient population. Analyses according to study design demonstrated consistent treatment effects across randomized and observational evidence, with no significant subgroup differences. CONCLUSION: In patients with ischemic cardiomyopathy and electromechanical dyssynchrony undergoing CABG, perioperative epicardial CRT implantation may be associated with decreased HF rehospitalization and all-cause mortality rates. However, given the limited number of included studies and small cumulative sample size, these findings should be considered hypothesis-generating, and large-scale confirmatory randomized trials are warranted. REGISTRATION: The study protocol was prospectively registered in PROSPERO. (CRID: CRD420251006918).