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Importance of angina in patients with coronary disease, heart failure, and left ventricular systolic dysfunction: insights from STICH.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2015 Nov 10; Vol. 66 (19), pp. 2092-2100. - Publication Year :
- 2015
-
Abstract
- 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.<br />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.<br />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.<br />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).<br />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).<br /> (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Angina Pectoris diagnosis
Angina Pectoris mortality
Cause of Death trends
Coronary Artery Disease mortality
Coronary Artery Disease physiopathology
Female
Follow-Up Studies
Global Health
Heart Failure mortality
Heart Failure physiopathology
Humans
Male
Middle Aged
Prognosis
Prospective Studies
Survival Rate trends
Systole
Ventricular Dysfunction, Left mortality
Ventricular Dysfunction, Left physiopathology
Angina Pectoris etiology
Coronary Artery Disease complications
Heart Failure complications
Ventricular Dysfunction, Left complications
Subjects
Details
- Language :
- English
- ISSN :
- 1558-3597
- Volume :
- 66
- Issue :
- 19
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 26541919
- Full Text :
- https://doi.org/10.1016/j.jacc.2015.08.882