Evidence map›Paper›PMID 28087687›Full record

SynthesisCirculation. Heart failure2017

Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients With Reduced Ejection Fraction and Coronary Artery Disease: A Meta-Analysis.

Georg Wolff, Dimitrios Dimitroulis, Felicita Andreotti, Michalina Kołodziejczak, Christian Jung, Pietro Scicchitano, Fiorella Devito, Annapaola Zito, Michele Occhipinti, Battistina Castiglioni and 5 more

Open access · bronzeAbstract readComparative StudyMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Circulation. Heart failure, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
68citing papers in PubMed, 3 pooled it
12.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

68 citing papers in PubMed, 3 syntheses or guidelines pooled it, 161 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Trial
  6. Article
  7. Review
  8. Review
  9. Article
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  12. Article
  13. Cardiometabolic Dysregulation and Heart Failure.Reviews in cardiovascular medicine · 2025
    Review
  14. Article
  15. Review
  16. Article
  17. Observational
  18. Article
  19. Article
  20. Review

8 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 4 institutions in 2 countries.

Georg WolffFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Dimitrios DimitroulisFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Felicita AndreottiFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Michalina KołodziejczakFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Christian JungFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Pietro ScicchitanoFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Fiorella DevitoFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Annapaola ZitoFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Michele OcchipintiFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Battistina CastiglioniFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Giuseppe CalveriFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Francesco MaisanoFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Marco M CicconeFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Stefano De ServiFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.).
Eliano P NavareseFrom the Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Milan, Italy (G.W., D.D., F.A., M.K., C.J., P.S., F.D., A.Z., M.O., M.M.C., S.D.S., E.P.N.); Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany (G.W., D.D., C.J.); Institute of Cardiology, Catholic University, Rome, Italy (F.A.); Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland (M.K.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (P.S., F.D., A.Z.); Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (M.O., B.C., G.C.); Department of Cardiosurgery, University of Zurich, Switzerland (F.M.); Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy (M.M.C.); and Department of Cardiology, Multimedica IRCCS, Milan, Italy (S.D.S., E.P.N.). elianonavarese@gmail.com.
University of Insubria · ITOspedale di Circolo e Fondazione Macchi · ITUniversity of Zurich · CHUniversity of Bari Aldo Moro · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHeart failure with reduced ejection fraction caused by ischemic heart disease is associated with increased morbidity and mortality. It remains unclear whether revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) carries benefits or risks in this group of stable patients compared with medical treatment. METHODS AND

resultsWe performed a meta-analysis of available studies comparing different methods of revascularization (PCI or CABG) against each other or medical treatment in patients with coronary artery disease and left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality; myocardial infarction, revascularization, and stroke were also analyzed. Twenty-one studies involving a total of 16 191 patients were included. Compared with medical treatment, there was a significant mortality reduction with CABG (hazard ratio, 0.66; 95% confidence interval, 0.61-0.72; P<0.001) and PCI (hazard ratio, 0.73; 95% confidence interval, 0.62-0.85; P<0.001). When compared with PCI, CABG still showed a survival benefit (hazard ratio, 0.82; 95% confidence interval, 0.75-0.90; P<0.001).

conclusionsThe present meta-analysis indicates that revascularization strategies are superior to medical treatment in improving survival in patients with ischemic heart disease and reduced ejection fraction. Between the 2 revascularization strategies, CABG seems more favorable compared with PCI in this particular clinical setting.

Indexed as

Coronary Artery BypassPercutaneous Coronary InterventionAgedCoronary Artery DiseaseFemaleHeart FailureHumansMaleMiddle AgedMyocardial InfarctionMyocardial IschemiaRisk AssessmentStroke VolumeSurvival Analysiscoronary artery bypasscoronary artery diseaseheart failuremeta-analysismyocardial infarction

Identifiers

PMID28087687
OpenAlexW2579564761

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.