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).