Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial

Jose C. Nicolau, Susanna R. Stevens, Hussein R. Al-Khalidi, Fabio B. Jatene, Remo H.M. Furtado, Luis A.O. Dallan, Luiz A.F. Lisboa, Patrice Desvigne-Nickens, Haissam Haddad, E. Marc Jolicoeur, Mark C. Petrie, Torsten Doenst, Robert E. Michler, E. Magnus Ohman, Jyotsna Maddury, Imtiaz Ali, Marek A. Deja, Jean L. Rouleau, Eric J. Velazquez, James A. Hill

Research output: Contribution to journalArticle

Abstract

Background: The STICH trial showed superiority of coronary artery bypass plus medical treatment (CABG) over medical treatment alone (MED) in patients with left ventricular ejection fraction (LVEF) ≤35%. In previous publications, percutaneous coronary intervention (PCI) prior to CABG was associated with worse prognosis. Objectives: The main purpose of this study was to analyse if prior PCI influenced outcomes in STICH. Methods and results: Patients in the STICH trial (n = 1212), followed for a median time of 9.8 years, were included in the present analyses. In the total population, 156 had a prior PCI (74 and 82, respectively, in the MED and CABG groups). In those with vs. without prior PCI, the adjusted hazard-ratios (aHRs) were 0.92 (95% CI = 0.74–1.15) for all-cause mortality, 0.85 (95% CI = 0.64–1.11) for CV mortality, and 1.43 (95% CI = 1.15–1.77) for CV hospitalization. In the group randomized to CABG without prior PCI, the aHRs were 0.82 (95% CI = 0.70–0.95) for all-cause mortality, 0.75 (95% CI = 0.62–0.90) for CV mortality and 0.67 (95% CI = 0.56–0.80) for CV hospitalization. In the group randomized to CABG with prior PCI, the aHRs were 0.76 (95% CI = 0.50–1.15) for all-cause mortality, 0.81 (95% CI = 0.49–1.36) for CV mortality and 0.61 (95% CI = 0.41–0.90) for CV hospitalization. There was no evidence of interaction between randomized treatment and prior PCI for any endpoint (all adjusted p > 0.05). Conclusion: In the STICH trial, prior PCI did not affect the outcomes of patients whether they were treated medically or surgically, and the superiority of CABG over MED remained unchanged regardless of prior PCI. Clinical trial registration: Clinicaltrials.gov; Identifier: NCT00023595

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StatePublished - Jan 1 2019

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Percutaneous Coronary Intervention
Angioplasty
Mortality
Hospitalization
Coronary Artery Bypass
Stroke Volume
Therapeutics
Clinical Trials

Keywords

  • Coronary artery bypass surgery
  • Heart failure
  • Left ventricular dysfunction
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Nicolau, J. C., Stevens, S. R., Al-Khalidi, H. R., Jatene, F. B., Furtado, R. H. M., Dallan, L. A. O., ... Hill, J. A. (2019). Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2019.03.029

Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial. / Nicolau, Jose C.; Stevens, Susanna R.; Al-Khalidi, Hussein R.; Jatene, Fabio B.; Furtado, Remo H.M.; Dallan, Luis A.O.; Lisboa, Luiz A.F.; Desvigne-Nickens, Patrice; Haddad, Haissam; Jolicoeur, E. Marc; Petrie, Mark C.; Doenst, Torsten; Michler, Robert E.; Ohman, E. Magnus; Maddury, Jyotsna; Ali, Imtiaz; Deja, Marek A.; Rouleau, Jean L.; Velazquez, Eric J.; Hill, James A.

In: International Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Nicolau, JC, Stevens, SR, Al-Khalidi, HR, Jatene, FB, Furtado, RHM, Dallan, LAO, Lisboa, LAF, Desvigne-Nickens, P, Haddad, H, Jolicoeur, EM, Petrie, MC, Doenst, T, Michler, RE, Ohman, EM, Maddury, J, Ali, I, Deja, MA, Rouleau, JL, Velazquez, EJ & Hill, JA 2019, 'Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial' International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2019.03.029
Nicolau, Jose C. ; Stevens, Susanna R. ; Al-Khalidi, Hussein R. ; Jatene, Fabio B. ; Furtado, Remo H.M. ; Dallan, Luis A.O. ; Lisboa, Luiz A.F. ; Desvigne-Nickens, Patrice ; Haddad, Haissam ; Jolicoeur, E. Marc ; Petrie, Mark C. ; Doenst, Torsten ; Michler, Robert E. ; Ohman, E. Magnus ; Maddury, Jyotsna ; Ali, Imtiaz ; Deja, Marek A. ; Rouleau, Jean L. ; Velazquez, Eric J. ; Hill, James A. / Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial. In: International Journal of Cardiology. 2019.
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title = "Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial",
abstract = "Background: The STICH trial showed superiority of coronary artery bypass plus medical treatment (CABG) over medical treatment alone (MED) in patients with left ventricular ejection fraction (LVEF) ≤35{\%}. In previous publications, percutaneous coronary intervention (PCI) prior to CABG was associated with worse prognosis. Objectives: The main purpose of this study was to analyse if prior PCI influenced outcomes in STICH. Methods and results: Patients in the STICH trial (n = 1212), followed for a median time of 9.8 years, were included in the present analyses. In the total population, 156 had a prior PCI (74 and 82, respectively, in the MED and CABG groups). In those with vs. without prior PCI, the adjusted hazard-ratios (aHRs) were 0.92 (95{\%} CI = 0.74–1.15) for all-cause mortality, 0.85 (95{\%} CI = 0.64–1.11) for CV mortality, and 1.43 (95{\%} CI = 1.15–1.77) for CV hospitalization. In the group randomized to CABG without prior PCI, the aHRs were 0.82 (95{\%} CI = 0.70–0.95) for all-cause mortality, 0.75 (95{\%} CI = 0.62–0.90) for CV mortality and 0.67 (95{\%} CI = 0.56–0.80) for CV hospitalization. In the group randomized to CABG with prior PCI, the aHRs were 0.76 (95{\%} CI = 0.50–1.15) for all-cause mortality, 0.81 (95{\%} CI = 0.49–1.36) for CV mortality and 0.61 (95{\%} CI = 0.41–0.90) for CV hospitalization. There was no evidence of interaction between randomized treatment and prior PCI for any endpoint (all adjusted p > 0.05). Conclusion: In the STICH trial, prior PCI did not affect the outcomes of patients whether they were treated medically or surgically, and the superiority of CABG over MED remained unchanged regardless of prior PCI. Clinical trial registration: Clinicaltrials.gov; Identifier: NCT00023595",
keywords = "Coronary artery bypass surgery, Heart failure, Left ventricular dysfunction, Percutaneous coronary intervention",
author = "Nicolau, {Jose C.} and Stevens, {Susanna R.} and Al-Khalidi, {Hussein R.} and Jatene, {Fabio B.} and Furtado, {Remo H.M.} and Dallan, {Luis A.O.} and Lisboa, {Luiz A.F.} and Patrice Desvigne-Nickens and Haissam Haddad and Jolicoeur, {E. Marc} and Petrie, {Mark C.} and Torsten Doenst and Michler, {Robert E.} and Ohman, {E. Magnus} and Jyotsna Maddury and Imtiaz Ali and Deja, {Marek A.} and Rouleau, {Jean L.} and Velazquez, {Eric J.} and Hill, {James A.}",
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T1 - Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial

AU - Nicolau, Jose C.

AU - Stevens, Susanna R.

AU - Al-Khalidi, Hussein R.

AU - Jatene, Fabio B.

AU - Furtado, Remo H.M.

AU - Dallan, Luis A.O.

AU - Lisboa, Luiz A.F.

AU - Desvigne-Nickens, Patrice

AU - Haddad, Haissam

AU - Jolicoeur, E. Marc

AU - Petrie, Mark C.

AU - Doenst, Torsten

AU - Michler, Robert E.

AU - Ohman, E. Magnus

AU - Maddury, Jyotsna

AU - Ali, Imtiaz

AU - Deja, Marek A.

AU - Rouleau, Jean L.

AU - Velazquez, Eric J.

AU - Hill, James A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The STICH trial showed superiority of coronary artery bypass plus medical treatment (CABG) over medical treatment alone (MED) in patients with left ventricular ejection fraction (LVEF) ≤35%. In previous publications, percutaneous coronary intervention (PCI) prior to CABG was associated with worse prognosis. Objectives: The main purpose of this study was to analyse if prior PCI influenced outcomes in STICH. Methods and results: Patients in the STICH trial (n = 1212), followed for a median time of 9.8 years, were included in the present analyses. In the total population, 156 had a prior PCI (74 and 82, respectively, in the MED and CABG groups). In those with vs. without prior PCI, the adjusted hazard-ratios (aHRs) were 0.92 (95% CI = 0.74–1.15) for all-cause mortality, 0.85 (95% CI = 0.64–1.11) for CV mortality, and 1.43 (95% CI = 1.15–1.77) for CV hospitalization. In the group randomized to CABG without prior PCI, the aHRs were 0.82 (95% CI = 0.70–0.95) for all-cause mortality, 0.75 (95% CI = 0.62–0.90) for CV mortality and 0.67 (95% CI = 0.56–0.80) for CV hospitalization. In the group randomized to CABG with prior PCI, the aHRs were 0.76 (95% CI = 0.50–1.15) for all-cause mortality, 0.81 (95% CI = 0.49–1.36) for CV mortality and 0.61 (95% CI = 0.41–0.90) for CV hospitalization. There was no evidence of interaction between randomized treatment and prior PCI for any endpoint (all adjusted p > 0.05). Conclusion: In the STICH trial, prior PCI did not affect the outcomes of patients whether they were treated medically or surgically, and the superiority of CABG over MED remained unchanged regardless of prior PCI. Clinical trial registration: Clinicaltrials.gov; Identifier: NCT00023595

AB - Background: The STICH trial showed superiority of coronary artery bypass plus medical treatment (CABG) over medical treatment alone (MED) in patients with left ventricular ejection fraction (LVEF) ≤35%. In previous publications, percutaneous coronary intervention (PCI) prior to CABG was associated with worse prognosis. Objectives: The main purpose of this study was to analyse if prior PCI influenced outcomes in STICH. Methods and results: Patients in the STICH trial (n = 1212), followed for a median time of 9.8 years, were included in the present analyses. In the total population, 156 had a prior PCI (74 and 82, respectively, in the MED and CABG groups). In those with vs. without prior PCI, the adjusted hazard-ratios (aHRs) were 0.92 (95% CI = 0.74–1.15) for all-cause mortality, 0.85 (95% CI = 0.64–1.11) for CV mortality, and 1.43 (95% CI = 1.15–1.77) for CV hospitalization. In the group randomized to CABG without prior PCI, the aHRs were 0.82 (95% CI = 0.70–0.95) for all-cause mortality, 0.75 (95% CI = 0.62–0.90) for CV mortality and 0.67 (95% CI = 0.56–0.80) for CV hospitalization. In the group randomized to CABG with prior PCI, the aHRs were 0.76 (95% CI = 0.50–1.15) for all-cause mortality, 0.81 (95% CI = 0.49–1.36) for CV mortality and 0.61 (95% CI = 0.41–0.90) for CV hospitalization. There was no evidence of interaction between randomized treatment and prior PCI for any endpoint (all adjusted p > 0.05). Conclusion: In the STICH trial, prior PCI did not affect the outcomes of patients whether they were treated medically or surgically, and the superiority of CABG over MED remained unchanged regardless of prior PCI. Clinical trial registration: Clinicaltrials.gov; Identifier: NCT00023595

KW - Coronary artery bypass surgery

KW - Heart failure

KW - Left ventricular dysfunction

KW - Percutaneous coronary intervention

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U2 - 10.1016/j.ijcard.2019.03.029

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