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

Research output: Contribution to journalArticle

29 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. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595)

Original languageEnglish (US)
Pages (from-to)2092-2100
Number of pages9
JournalJournal of the American College of Cardiology
Volume66
Issue number19
DOIs
StatePublished - 2015

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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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