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J Am Coll Cardiol. 2015 Nov 10;66(19):2092-2100. doi: 10.1016/j.jacc.2015.08.882.

Importance of angina in patients with coronary disease, heart failure, and left ventricular systolic dysfunction: insights from STICH.

Author information

1
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
2
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
3
IRCCS Policlinico San Donato, Milan, Italy.
4
National Institute of Cardiology, Warsaw, Poland.
5
National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland.
6
Golden Jubilee National Hospital, Glasgow, United Kingdom.
7
Auckland City Hospital, Auckland, New Zealand.
8
British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
9
Westchester Medical Center and New York Medical College, Valhalla, New York.
10
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
11
Allina Health, Minneapolis, Minnesota.
12
National Heart Centre, Singapore, Singapore.
13
National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, United Kingdom. Electronic address: j.cleland@imperial.ac.uk.

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.

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).

KEYWORDS:

coronary artery bypass grafting; coronary artery disease; heart failure; mortality

PMID:
26541919
PMCID:
PMC4655599
DOI:
10.1016/j.jacc.2015.08.882
[Indexed for MEDLINE]
Free PMC Article

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