Importance of Angina in Patients With Coronary Disease, Heart Failure, and Left Ventricular Systolic Dysfunction Insights From STICH

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:66

Article

Jolicoeur, E. Marc¹  Dunning, Allison²  Castelvecchio, Serenella³  Dabrowski, Rafal⁴  Waclawiw, Myron A.⁵  Petrie, Mark C.⁶  Stewart, Ralph⁷  Jhund, Pardeep S.⁸  Desvigne-Nickens, Patrice⁵  Panza, Julio A.^9,10  Bonow, Robert O.¹¹  Sun, Benjamin¹²  San, Tan Ru¹³  Al-Khalidi, Hussein R.²  Rouleau, Jean L.¹  Velazquez, Eric J.²  Cleland, John G. F.^14,15 

[1] Univ Montreal, Montreal Heart Inst, Dept Med, Montreal, PQ, Canada

[2] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA

[3] IRCCS Policlin San Donato, Milan, Italy

[4] Natl Inst Cardiol, Warsaw, Poland

[5] NHLBI, NIH, Bethesda, MD 20892 USA

[6] Golden Jubilee Natl Hosp, Glasgow, Lanark, Scotland

[7] Auckland City Hosp, Auckland, New Zealand

[8] Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, Glasgow, Lanark, Scotland

[9] Westchester Cty Med Ctr, Valhalla, NY 10595 USA

[10] New York Med Coll, Valhalla, NY 10595 USA

[11] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA

[12] Allina Hlth, Minneapolis, MN USA

[13] Natl Heart Ctr, Singapore, Singapore

[14] Univ London Imperial Coll Sci Technol & Med, Royal Brompton Hosp, Natl Heart & Lung Inst, London, England

[15] Univ London Imperial Coll Sci Technol & Med, Harefield Hosp, Natl Heart & Lung Inst, London, England

关键词: coronary artery bypass grafting;    coronary artery disease;    heart failure;    mortality;   

DOI  :  10.1016/j.jacc.2015.08.882

来源: Elsevier

【 摘 要 】

BACKGROUND Patients with left ventricular (LV) systolic dysfunction, coronary artery disease (CAD), and angina are often thought to have a worse prognosis and a greater prognostic benefit from coronary artery bypass graft (CABG) surgery than those without angina. OBJECTIVES This study investigated: 1) whether angina was associated with a worse prognosis; 2) whether angina identified patients who had a greater survival benefit from CABG; and 3) whether CABG improved angina in patients with LV systolic dysfunction and CAD. METHODS We performed an analysis of the STICH (Surgical Treatment for Ischemic Heart Failure) trial, in which 1,212 patients with an ejection fraction <= 35% and CAD were randomized to CABG or medical therapy. Multivariable Cox and logistic models were used to assess long-term clinical outcomes. RESULTS At baseline, 770 patients (64%) reported angina. Among patients assigned to medical therapy, all-cause mortality was similar in patients with and without angina (hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 0.79 to 1.38). The effect of CABG was similar whether the patient had angina (HR: 0.89; 95% CI: 0.71 to 1.13) or not (HR: 0.68; 95% CI: 0.50 to 0.94; p interaction = 0.14). Patients assigned to CABG were more likely to report improvement in angina than those assigned to medical therapy alone (odds ratio: 0.70; 95% CI: 0.55 to 0.90; p < 0.01). CONCLUSIONS Angina does not predict all-cause mortality in medically treated patients with LV systolic dysfunction and CAD, nor does it identify patients who have a greater survival benefit from CABG. However, CABG does improve angina to a greater extent than medical therapy alone. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595) (C) 2015 by the American College of Cardiology Foundation.

【 授权许可】

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