Burden of medical co-morbidities and benefit from surgical revascularization in patients with ischaemic cardiomyopathy

on behalf of the STICH Trial Investigators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Aims: The landmark STICH trial found that surgical revascularization compared to medical therapy alone improved survival in patients with heart failure (HF) of ischaemic aetiology and an ejection fraction (EF) ≤ 35%. However, the interaction between the burden of medical co-morbidities and the benefit from surgical revascularization has not been previously described in patients with ischaemic cardiomyopathy. Methods and results: The STICH trial (ClinicalTrials.gov Identifier: NCT00023595) enrolled patients ≥ 18 years of age with coronary artery disease amenable to coronary artery bypass grafting (CABG) and an EF ≤ 35%. Eligible participants were randomly assigned 1:1 to receive medical therapy (MED) (n = 602) or MED/CABG (n = 610). A modified Charlson co-morbidity index (CCI) based on the availability of data and study definitions was calculated by summing the weighted points for all co-morbid conditions. Patients were divided into mild/moderate (CCI 1–4) and severe (CCI ≥ 5) co-morbidity. Cox proportional hazards models were used to evaluate the association between CCI and outcomes and the interaction between severity of co-morbidity and treatment effect. The study population included 349 patients (29%) with a mild/moderate CCI score and 863 patients (71%) with a severe CCI score. Patients with a severe CCI score had greater functional limitations based on 6-min walk test and impairments in health-related quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire. A total of 161 patients (Kaplan–Meier rate = 50%) with a mild/moderate CCI score and 579 patients (Kaplan–Meier rate = 69%) with a severe CCI score died over a median follow-up of 9.8 years. After adjusting for baseline confounders, patients with a severe CCI score were at higher risk for all-cause mortality (hazard ratio 1.44, 95% confidence interval 1.19–1.74; P < 0.001). There was no interaction between CCI score and treatment effect on survival (P = 0.756). Conclusions: More than 70% of patients had a severe burden of medical co-morbidities at baseline, which was independently associated with increased risk of death. There was not a differential benefit of surgical revascularization with respect to survival based on severity of co-morbidity.

Original languageEnglish (US)
JournalEuropean Journal of Heart Failure
DOIs
StatePublished - Jan 1 2019

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Cardiomyopathies
Morbidity
Coronary Artery Bypass
Survival
Therapeutics
Proportional Hazards Models
Coronary Artery Disease

Keywords

  • Coronary artery bypass grafting
  • Heart failure
  • Ischaemic cardiomyopathy
  • Multimorbidity
  • Reduced ejection fraction
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Burden of medical co-morbidities and benefit from surgical revascularization in patients with ischaemic cardiomyopathy. / on behalf of the STICH Trial Investigators.

In: European Journal of Heart Failure, 01.01.2019.

Research output: Contribution to journalArticle

@article{5a79a83fc45e447e910dd9fb46a18131,
title = "Burden of medical co-morbidities and benefit from surgical revascularization in patients with ischaemic cardiomyopathy",
abstract = "Aims: The landmark STICH trial found that surgical revascularization compared to medical therapy alone improved survival in patients with heart failure (HF) of ischaemic aetiology and an ejection fraction (EF) ≤ 35{\%}. However, the interaction between the burden of medical co-morbidities and the benefit from surgical revascularization has not been previously described in patients with ischaemic cardiomyopathy. Methods and results: The STICH trial (ClinicalTrials.gov Identifier: NCT00023595) enrolled patients ≥ 18 years of age with coronary artery disease amenable to coronary artery bypass grafting (CABG) and an EF ≤ 35{\%}. Eligible participants were randomly assigned 1:1 to receive medical therapy (MED) (n = 602) or MED/CABG (n = 610). A modified Charlson co-morbidity index (CCI) based on the availability of data and study definitions was calculated by summing the weighted points for all co-morbid conditions. Patients were divided into mild/moderate (CCI 1–4) and severe (CCI ≥ 5) co-morbidity. Cox proportional hazards models were used to evaluate the association between CCI and outcomes and the interaction between severity of co-morbidity and treatment effect. The study population included 349 patients (29{\%}) with a mild/moderate CCI score and 863 patients (71{\%}) with a severe CCI score. Patients with a severe CCI score had greater functional limitations based on 6-min walk test and impairments in health-related quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire. A total of 161 patients (Kaplan–Meier rate = 50{\%}) with a mild/moderate CCI score and 579 patients (Kaplan–Meier rate = 69{\%}) with a severe CCI score died over a median follow-up of 9.8 years. After adjusting for baseline confounders, patients with a severe CCI score were at higher risk for all-cause mortality (hazard ratio 1.44, 95{\%} confidence interval 1.19–1.74; P < 0.001). There was no interaction between CCI score and treatment effect on survival (P = 0.756). Conclusions: More than 70{\%} of patients had a severe burden of medical co-morbidities at baseline, which was independently associated with increased risk of death. There was not a differential benefit of surgical revascularization with respect to survival based on severity of co-morbidity.",
keywords = "Coronary artery bypass grafting, Heart failure, Ischaemic cardiomyopathy, Multimorbidity, Reduced ejection fraction, Survival",
author = "{on behalf of the STICH Trial Investigators} and Ambrosy, {Andrew P.} and Stevens, {Susanna R.} and Al-Khalidi, {Hussein R.} and Rouleau, {Jean L.} and Nadia Bouabdallaoui and Carson, {Peter E.} and Christopher Adlbrecht and Cleland, {John G.F.} and Rafal Dabrowski and Golba, {Krzysztof S.} and Pina, {Ileana L.} and Sueta, {Carla A.} and Ambuj Roy and George Sopko and Bonow, {Robert O.} and Velazquez, {Eric J.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/ejhf.1404",
language = "English (US)",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",

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TY - JOUR

T1 - Burden of medical co-morbidities and benefit from surgical revascularization in patients with ischaemic cardiomyopathy

AU - on behalf of the STICH Trial Investigators

AU - Ambrosy, Andrew P.

AU - Stevens, Susanna R.

AU - Al-Khalidi, Hussein R.

AU - Rouleau, Jean L.

AU - Bouabdallaoui, Nadia

AU - Carson, Peter E.

AU - Adlbrecht, Christopher

AU - Cleland, John G.F.

AU - Dabrowski, Rafal

AU - Golba, Krzysztof S.

AU - Pina, Ileana L.

AU - Sueta, Carla A.

AU - Roy, Ambuj

AU - Sopko, George

AU - Bonow, Robert O.

AU - Velazquez, Eric J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: The landmark STICH trial found that surgical revascularization compared to medical therapy alone improved survival in patients with heart failure (HF) of ischaemic aetiology and an ejection fraction (EF) ≤ 35%. However, the interaction between the burden of medical co-morbidities and the benefit from surgical revascularization has not been previously described in patients with ischaemic cardiomyopathy. Methods and results: The STICH trial (ClinicalTrials.gov Identifier: NCT00023595) enrolled patients ≥ 18 years of age with coronary artery disease amenable to coronary artery bypass grafting (CABG) and an EF ≤ 35%. Eligible participants were randomly assigned 1:1 to receive medical therapy (MED) (n = 602) or MED/CABG (n = 610). A modified Charlson co-morbidity index (CCI) based on the availability of data and study definitions was calculated by summing the weighted points for all co-morbid conditions. Patients were divided into mild/moderate (CCI 1–4) and severe (CCI ≥ 5) co-morbidity. Cox proportional hazards models were used to evaluate the association between CCI and outcomes and the interaction between severity of co-morbidity and treatment effect. The study population included 349 patients (29%) with a mild/moderate CCI score and 863 patients (71%) with a severe CCI score. Patients with a severe CCI score had greater functional limitations based on 6-min walk test and impairments in health-related quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire. A total of 161 patients (Kaplan–Meier rate = 50%) with a mild/moderate CCI score and 579 patients (Kaplan–Meier rate = 69%) with a severe CCI score died over a median follow-up of 9.8 years. After adjusting for baseline confounders, patients with a severe CCI score were at higher risk for all-cause mortality (hazard ratio 1.44, 95% confidence interval 1.19–1.74; P < 0.001). There was no interaction between CCI score and treatment effect on survival (P = 0.756). Conclusions: More than 70% of patients had a severe burden of medical co-morbidities at baseline, which was independently associated with increased risk of death. There was not a differential benefit of surgical revascularization with respect to survival based on severity of co-morbidity.

AB - Aims: The landmark STICH trial found that surgical revascularization compared to medical therapy alone improved survival in patients with heart failure (HF) of ischaemic aetiology and an ejection fraction (EF) ≤ 35%. However, the interaction between the burden of medical co-morbidities and the benefit from surgical revascularization has not been previously described in patients with ischaemic cardiomyopathy. Methods and results: The STICH trial (ClinicalTrials.gov Identifier: NCT00023595) enrolled patients ≥ 18 years of age with coronary artery disease amenable to coronary artery bypass grafting (CABG) and an EF ≤ 35%. Eligible participants were randomly assigned 1:1 to receive medical therapy (MED) (n = 602) or MED/CABG (n = 610). A modified Charlson co-morbidity index (CCI) based on the availability of data and study definitions was calculated by summing the weighted points for all co-morbid conditions. Patients were divided into mild/moderate (CCI 1–4) and severe (CCI ≥ 5) co-morbidity. Cox proportional hazards models were used to evaluate the association between CCI and outcomes and the interaction between severity of co-morbidity and treatment effect. The study population included 349 patients (29%) with a mild/moderate CCI score and 863 patients (71%) with a severe CCI score. Patients with a severe CCI score had greater functional limitations based on 6-min walk test and impairments in health-related quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire. A total of 161 patients (Kaplan–Meier rate = 50%) with a mild/moderate CCI score and 579 patients (Kaplan–Meier rate = 69%) with a severe CCI score died over a median follow-up of 9.8 years. After adjusting for baseline confounders, patients with a severe CCI score were at higher risk for all-cause mortality (hazard ratio 1.44, 95% confidence interval 1.19–1.74; P < 0.001). There was no interaction between CCI score and treatment effect on survival (P = 0.756). Conclusions: More than 70% of patients had a severe burden of medical co-morbidities at baseline, which was independently associated with increased risk of death. There was not a differential benefit of surgical revascularization with respect to survival based on severity of co-morbidity.

KW - Coronary artery bypass grafting

KW - Heart failure

KW - Ischaemic cardiomyopathy

KW - Multimorbidity

KW - Reduced ejection fraction

KW - Survival

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U2 - 10.1002/ejhf.1404

DO - 10.1002/ejhf.1404

M3 - Article

C2 - 30698316

AN - SCOPUS:85060994568

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

ER -