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)
Full text not currently available from Enlighten.
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: | Jhund, Professor Pardeep and Petrie, Professor Mark and Cleland, Professor John |
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 > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
Journal Name: | Journal of the American College of Cardiology |
Publisher: | Elsevier |
ISSN: | 0735-1097 |
Published Online: | 02 November 2015 |
University Staff: Request a correction | Enlighten Editors: Update this record