Abstract | BACKGROUND: METHODS: A total of 1212 patients (median follow-up, 9.8 years) with ejection fraction ≤35% and coronary disease amenable to CABG were randomized to CABG or MED in the STICH trial (Surgical Treatment for Ischemic Heart Failure). RESULTS: Mean age at trial entry was 60 years; 12% were women; 36% were nonwhite; and the baseline ejection fraction was 28%. For the present analyses, patients were categorized by age quartiles: quartile 1, ≤54 years; quartile, 2 >54 and ≤60 years; quartile 3, >60 and ≤67 years; and quartile 4, >67 years. Older versus younger patients had more comorbidities. All-cause mortality was higher in older compared with younger patients assigned to MED (79% versus 60% for quartiles 4 and 1, respectively; log-rank P=0.005) and CABG (68% versus 48% for quartiles 4 and 1, respectively; log-rank P<0.001). In contrast, cardiovascular mortality was not statistically significantly different across the spectrum of age in the MED group (53% versus 49% for quartiles 4 and 1, respectively; log-rank P=0.388) or CABG group (39% versus 35% for quartiles 4 and 1, respectively; log-rank P=0.103). Cardiovascular deaths accounted for a greater proportion of deaths in the youngest versus oldest quartile (79% versus 62%). The effect of CABG versus MED on all-cause mortality tended to diminish with increasing age (Pinteraction=0.062), whereas the benefit of CABG on cardiovascular mortality was consistent over all ages (Pinteraction=0.307). There was a greater reduction in all-cause mortality or cardiovascular hospitalization with CABG versus MED in younger compared with older patients (Pinteraction=0.004). In the CABG group, cardiopulmonary bypass time or days in intensive care did not differ for older versus younger patients. CONCLUSIONS: CABG added to MED has a more substantial benefit on all-cause mortality and the combination of all-cause mortality and cardiovascular hospitalization in younger compared with older patients. CABG added to MED has a consistent beneficial effect on cardiovascular mortality regardless of age. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.
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Authors | Mark C Petrie, Pardeep S Jhund, Lilin She, Christopher Adlbrecht, Torsten Doenst, Julio A Panza, James A Hill, Kerry L Lee, Jean L Rouleau, David L Prior, Imtiaz S Ali, Jyotsna Maddury, Krzysztof S Golba, Harvey D White, Peter Carson, Lukasz Chrzanowski, Alexander Romanov, Alan B Miller, Eric J Velazquez, STICH Trial Investigators |
Journal | Circulation
(Circulation)
Vol. 134
Issue 18
Pg. 1314-1324
(Nov 01 2016)
ISSN: 1524-4539 [Electronic] United States |
PMID | 27573034
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
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Copyright | © 2016 American Heart Association, Inc. |
Topics |
- Age Factors
- Aged
- Coronary Artery Bypass
- Disease-Free Survival
- Female
- Follow-Up Studies
- Heart Failure
(mortality, physiopathology, surgery)
- Humans
- Male
- Middle Aged
- Myocardial Ischemia
(mortality, physiopathology, surgery)
- Stroke Volume
- Survival Rate
- Ventricular Dysfunction, Left
(mortality, physiopathology, surgery)
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