TY - JOUR
T1 - Coronary-artery bypass surgery in patients with ischemic cardiomyopathy
AU - Velazquez, Eric J.
AU - Lee, Kerry L.
AU - Jones, Robert H.
AU - Al-Khalidi, Hussein R.
AU - Hill, James A.
AU - Panza, Julio A.
AU - Michler, Robert E.
AU - Bonow, Robert O.
AU - Doenst, Torsten
AU - Petrie, Mark C.
AU - Oh, Jae K.
AU - She, Lilin
AU - Moore, Vanessa L.
AU - Desvigne-Nickens, Patrice
AU - Sopko, George
AU - Rouleau, Jean L.
N1 - Funding Information:
(Funded by the National Institutes of Health; STICH [and STICHES] ClinicalTrials.gov number, NCT00023595.) This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute of the National Institutes of Health. STICHES was supported by a grant (R01-HL105853/NCT NCT00023595) from the National Institutes of Health. Dr. Velazquez reports receiving consulting or advisory board fees from Amgen, Merck, and Novartis, lecture fees from Novartis and Spire Learning, and grant support from Abbott, Medtronic, Alnylam, Amgen, Pfizer, and Novartis; and Dr. Rouleau, receiving consulting fees from Novartis. No other potential conflict of interest relevant to this article was reported. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Publisher Copyright:
Copyright © 2016 Massachusetts Medical Society. All rights reserved.
PY - 2016/4/21
Y1 - 2016/4/21
N2 - BACKGROUND The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear. METHODS From July 2002 to May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to undergo CABG plus medical therapy (CABG group, 610 patients) or medical therapy alone (medical-therapy group, 602 patients). The primary outcome was death from any cause. Major secondary outcomes included death from cardiovascular causes and death from any cause or hospitalization for cardiovascular causes. The median duration of follow-up, including the current extended-follow-up study, was 9.8 years. RESULTS A primary outcome event occurred in 359 patients (58.9%) in the CABG group and in 398 patients (66.1%) in the medical-therapy group (hazard ratio with CABG vs. medical therapy, 0.84; 95% confidence interval [CI], 0.73 to 0.97; P = 0.02 by log-rank test). A total of 247 patients (40.5%) in the CABG group and 297 patients (49.3%) in the medical-therapy group died from cardiovascular causes (hazard ratio, 0.79; 95% CI, 0.66 to 0.93; P = 0.006 by log-rank test). Death from any cause or hospitalization for cardiovascular causes occurred in 467 patients (76.6%) in the CABG group and in 524 patients (87.0%) in the medical-therapy group (hazard ratio, 0.72; 95% CI, 0.64 to 0.82; P<0.001 by log-rank test). CONCLUSIONS In a cohort of patients with ischemic cardiomyopathy, the rates of death from any cause, death from cardiovascular causes, and death from any cause or hospitalization for cardiovascular causes were significantly lower over 10 years among patients who underwent CABG in addition to receiving medical therapy than among those who received medical therapy alone.
AB - BACKGROUND The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear. METHODS From July 2002 to May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to undergo CABG plus medical therapy (CABG group, 610 patients) or medical therapy alone (medical-therapy group, 602 patients). The primary outcome was death from any cause. Major secondary outcomes included death from cardiovascular causes and death from any cause or hospitalization for cardiovascular causes. The median duration of follow-up, including the current extended-follow-up study, was 9.8 years. RESULTS A primary outcome event occurred in 359 patients (58.9%) in the CABG group and in 398 patients (66.1%) in the medical-therapy group (hazard ratio with CABG vs. medical therapy, 0.84; 95% confidence interval [CI], 0.73 to 0.97; P = 0.02 by log-rank test). A total of 247 patients (40.5%) in the CABG group and 297 patients (49.3%) in the medical-therapy group died from cardiovascular causes (hazard ratio, 0.79; 95% CI, 0.66 to 0.93; P = 0.006 by log-rank test). Death from any cause or hospitalization for cardiovascular causes occurred in 467 patients (76.6%) in the CABG group and in 524 patients (87.0%) in the medical-therapy group (hazard ratio, 0.72; 95% CI, 0.64 to 0.82; P<0.001 by log-rank test). CONCLUSIONS In a cohort of patients with ischemic cardiomyopathy, the rates of death from any cause, death from cardiovascular causes, and death from any cause or hospitalization for cardiovascular causes were significantly lower over 10 years among patients who underwent CABG in addition to receiving medical therapy than among those who received medical therapy alone.
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U2 - 10.1056/NEJMoa1602001
DO - 10.1056/NEJMoa1602001
M3 - Article
C2 - 27040723
AN - SCOPUS:84964475913
SN - 0028-4793
VL - 374
SP - 1511
EP - 1520
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 16
ER -