Better long-term outcomes after coronary artery bypass grafting compared with percutaneous coronary intervention in ischemic heart disease with reduced left ventricular function: A systematic review

The choice of the optimal myocardial revascularization strategy in patients with coronary artery disease, multivessel coronary artery disease, and reduced left ventricular function remains one of the most pressing and controversial issues in modern cardiology and cardiovascular surgery. Despite significant progress in the development of percutaneous coronary intervention techniques and the refinement of coronary artery bypass grafting (CABG) surgical technologies, the preferred method for restoring coronary blood flow in this patient population remains actively debated. Evaluation of long-term clinical outcomes, including survival, the risk of cardiovascular complications, and the need for repeat revascularization procedures, is particularly important.The aim of this study was to conduct a comparative analysis of the efficacy and safety of percutaneous coronary intervention and CABG in adult patients with coronary artery disease, including those with reduced left ventricular function, based on current scientific evidence. A systematic literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Publications were searched in the international databases PubMed, Scopus, Web of Science, and Embase from January 2020 to May 2026. The review included randomized controlled trials and prospective and retrospective cohort studies that reported direct comparisons of percutaneous coronary intervention and coronary artery bypass grafting in adult patients with coronary artery disease. Due to significant clinical and methodological heterogeneity among the studies, a qualitative data synthesis was conducted rather than a quantitative meta-analysis.Results. Analysis of the included studies showed that both revascularization strategies had comparable rates of all-cause and in-hospital mortality during short- and medium-term follow-up periods. However, in the long term, coronary artery bypass grafting demonstrates more favorable outcomes, characterized by a reduced incidence of major adverse cardiovascular and cerebrovascular events, myocardial infarction, and repeated coronary interventions. The most pronounced benefit of surgical revascularization is observed in patients with three-vessel coronary disease, left main coronary artery disease, and a marked reduction in left ventricular ejection fraction. Percutaneous coronary intervention (PCI) retains its importance as a less invasive treatment option in patients with less complex coronary artery disease anatomy and a high risk of surgical intervention.Conclusion. Current data indicate that CABG remains the preferred revascularization strategy for most patients with extensive coronary atherosclerosis and reduced left ventricular function due to its superior long-term clinical outcomes, while PCI is an effective alternative in carefully selected clinical situations. A personalized approach to treatment selection, taking into account the anatomical features of the coronary artery, the degree of left ventricular dysfunction, and surgical risk, can improve treatment efficacy and patient prognosis.PROSPERO registration: CRD420261437422.