Objective:

To investigate the impact of complete revascularization (CR) versus incomplete revascularization (ICR) on the composite outcome of first hospitalization for heart failure (HF) or cardiovascular death in patients with acute coronary syndrome (ACS) and a left ventricular ejection fraction (LVEF) ≥ 40%, highlighting the significance of LVEF in heart failure risk.

Key Findings:

• 4.6% of CR patients and 7.8% of ICR patients reached the primary endpoint (p < 0.001), indicating a significant difference in outcomes.
• CR was associated with a lower risk of the primary endpoint in patients with LVEF <50% (HR 0.46; 95% CI, 0.22–0.96), suggesting a critical threshold for intervention.
• The benefit of CR was significant in NSTE–ACS patients (HR 0.41; 95% CI 0.20–0.83) but not in STEMI patients, highlighting the need for tailored approaches.

Interpretation:

CR significantly reduces the risk of HF hospitalization or cardiovascular death in patients with LVEF 40%–50%, with diminishing benefits as LVEF increases, aligning with existing literature on heart failure outcomes.

Limitations:

• Observational nature of the study may introduce biases.
• Potential for residual confounding, which could affect the validity of the findings.

Conclusion:

CR is associated with reduced HF risk in patients with LVEF 40%–50%, suggesting LVEF-dependent efficacy that should be considered in clinical practice.