Importance of angina in patients with coronary disease, heart failure, and left ventricular systolic dysfunction

Jolicœur, E. M. et al. (2015) Importance of angina in patients with coronary disease, heart failure, and left ventricular systolic dysfunction. Journal of the American College of Cardiology, 66(19), pp. 2092-2100. (doi:10.1016/j.jacc.2015.08.882) (PMID:26541919)

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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).

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Jhund, Dr Pardeep and Petrie, Professor Mark
Authors: Jolicœur, E. M., Dunning, A., Castelvecchio, S., Dabrowski, R., Waclawiw, M. A., Petrie, M. C., Stewart, R., Jhund, P. S., Desvigne-Nickens, P., Panza, J. A., Bonow, R. O., Sun, B., San, T. R., Al-Khalidi, H. R., Rouleau, J. L., Velazquez, E. J., and Cleland, J. G.F.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Journal of the American College of Cardiology
Publisher:Elsevier
ISSN:0735-1097
Published Online:02 November 2015

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