Importance of Angina in Patients with Coronary Disease, Heart Failure, and Left Ventricular Systolic Dysfunction Insights from STICH

E. Marc Jolicœur; Allison Dunning; Serenella Castelvecchio; Rafal Dabrowski; Myron A. Waclawiw; Mark C. Petrie; Ralph Stewart; Pardeep S. Jhund; Patrice Desvigne-Nickens; Julio A. Panza; Robert O. Bonow; Benjamin Sun; Tan Ru San; Hussein R. Al-Khalidi; Jean L. Rouleau; Eric J. Velazquez; John G.F. Cleland

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

E. Marc Jolicœur, Allison Dunning, Serenella Castelvecchio, Rafal Dabrowski, Myron A. Waclawiw, Mark C. Petrie, Ralph Stewart, Pardeep S. Jhund, Patrice Desvigne-Nickens, Julio A. Panza, Robert O. Bonow, Benjamin Sun, Tan Ru San, Hussein R. Al-Khalidi, Jean L. Rouleau, Eric J. Velazquez, John G.F. Cleland^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

55 Scopus citations

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.

Original language	English (US)
Pages (from-to)	2092-2100
Number of pages	9
Journal	Journal of the American College of Cardiology
Volume	66
Issue number	19
DOIs	https://doi.org/10.1016/j.jacc.2015.08.882
State	Published - 2015

Funding

This work was supported by grants U01HL69015 and U01HL69013 from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Maryland. This work is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI or National Institutes of Health. Dr. Jolicoeur is supported by research grants from les Fonds la Recherche du Québec en santé (FRQS), the Canadian Institutes for Health Research (CIHR), and la Fondation de l''Institut de Cardiologie de Montréal. Dr. Sun has served on an advisory committee for Sunshine Heart. Dr. Velazquez has received research grants from Alnylam Pharmaceuticals and GlaxoSmithKline; research funding from the NHLBI; served on the speakers bureau for Novartis; and has served on advisory committees for Novartis and Merck. Dr. Cleland has received research grants, has received speakers fees from, and served on advisory boards for Amgen, Servier, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This work was supported by grants U01HL69015 and U01HL69013 from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Maryland. This work is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI or National Institutes of Health. Dr. Jolicœur is supported by research grants from les Fonds la Recherche du Québec en santé (FRQS), the Canadian Institutes for Health Research (CIHR), and la Fondation de l’Institut de Cardiologie de Montréal. Dr. Sun has served on an advisory committee for Sunshine Heart. Dr. Velazquez has received research grants from Alnylam Pharmaceuticals and GlaxoSmithKline; research funding from the NHLBI; served on the speakers bureau for Novartis; and has served on advisory committees for Novartis and Merck. Dr. Cleland has received research grants, has received speakers fees from, and served on advisory boards for Amgen, Servier, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Keywords

coronary artery bypass grafting
coronary artery disease
heart failure
mortality

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jacc.2015.08.882

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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., & Cleland, J. G. F. (2015). Importance of Angina in Patients with Coronary Disease, Heart Failure, and Left Ventricular Systolic Dysfunction Insights from STICH. Journal of the American College of Cardiology, 66(19), 2092-2100. https://doi.org/10.1016/j.jacc.2015.08.882

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title = "Importance of Angina in Patients with Coronary Disease, Heart Failure, and Left Ventricular Systolic Dysfunction Insights from STICH",

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.",

keywords = "coronary artery bypass grafting, coronary artery disease, heart failure, mortality",

author = "Jolic{\oe}ur, {E. Marc} and Allison Dunning and Serenella Castelvecchio and Rafal Dabrowski and Waclawiw, {Myron A.} and Petrie, {Mark C.} and Ralph Stewart and Jhund, {Pardeep S.} and Patrice Desvigne-Nickens and Panza, {Julio A.} and Bonow, {Robert O.} and Benjamin Sun and San, {Tan Ru} and Al-Khalidi, {Hussein R.} and Rouleau, {Jean L.} and Velazquez, {Eric J.} and Cleland, {John G.F.}",

note = "Publisher Copyright: {\textcopyright} 2015 American College of Cardiology Foundation.",

year = "2015",

doi = "10.1016/j.jacc.2015.08.882",

language = "English (US)",

volume = "66",

pages = "2092--2100",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "19",

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Jolicœur, EM, Dunning, A, Castelvecchio, S, Dabrowski, R, Waclawiw, MA, Petrie, MC, Stewart, R, Jhund, PS, Desvigne-Nickens, P, Panza, JA, Bonow, RO, Sun, B, San, TR, Al-Khalidi, HR, Rouleau, JL, Velazquez, EJ & Cleland, JGF 2015, 'Importance of Angina in Patients with Coronary Disease, Heart Failure, and Left Ventricular Systolic Dysfunction Insights from STICH', Journal of the American College of Cardiology, vol. 66, no. 19, pp. 2092-2100. https://doi.org/10.1016/j.jacc.2015.08.882

TY - JOUR

T1 - Importance of Angina in Patients with Coronary Disease, Heart Failure, and Left Ventricular Systolic Dysfunction Insights from STICH

AU - Jolicœur, E. Marc

AU - Dunning, Allison

AU - Castelvecchio, Serenella

AU - Dabrowski, Rafal

AU - Waclawiw, Myron A.

AU - Petrie, Mark C.

AU - Stewart, Ralph

AU - Jhund, Pardeep S.

AU - Desvigne-Nickens, Patrice

AU - Panza, Julio A.

AU - Bonow, Robert O.

AU - Sun, Benjamin

AU - San, Tan Ru

AU - Al-Khalidi, Hussein R.

AU - Rouleau, Jean L.

AU - Velazquez, Eric J.

AU - Cleland, John G.F.

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

KW - coronary artery bypass grafting

KW - coronary artery disease

KW - heart failure

KW - mortality

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SN - 0735-1097

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

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ER -

Importance of Angina in Patients with Coronary Disease, Heart Failure, and Left Ventricular Systolic Dysfunction Insights from STICH

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