Exercise Capacity and Mortality in Patients With Ischemic Left Ventricular Dysfunction Randomized to Coronary Artery Bypass Graft Surgery or Medical Therapy. An Analysis From the STICH Trial (Surgical Treatment for Ischemic Heart Failure)

Ralph A H Stewart, Dominika Szalewska, Lilin She, Kerry L. Lee, Mark H. Drazner, Barbara Lubiszewska, Dragana Kosevic, Permyos Ruengsakulrach, José C. Nicolau, Benoit Coutu, Shiv K. Choudhary, Daniel B. Mark, John G F Cleland, Ileana L. Pina, Eric J. Velazquez, Andrzej Rynkiewicz, Harvey White

Research output: Contribution to journalArticle

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Abstract

Objectives: The objective of this study was to assess the prognostic significance of exercise capacity in patients with ischemic left ventricular (LV) dysfunction eligible for coronary artery bypass graft surgery (CABG). Background: Poor exercise capacity is associated with mortality, but it is not known how this influences the benefits and risks of CABG compared with medical therapy. Methods: In an exploratory analysis, physical activity was assessed by questionnaire and 6-min walk test in 1,212 patients before randomization to CABG (n = 610) or medical management (n = 602) in the STICH (Surgical Treatment for Ischemic Heart Failure) trial. Mortality (n = 462) was compared by treatment allocation during 56 months (interquartile range: 48 to 68 months) of follow-up for subjects able (n = 682) and unable (n = 530) to walk 300 m in 6 min and with less (Physical Ability Score [PAS] >55, n = 749) and more (PAS ≤55, n = 433) limitation by dyspnea or fatigue. Results: Compared with medical therapy, mortality was lower for patients randomized to CABG who walked ≥300 m (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.59 to 0.99; p = 0.038) and those with a PAS >55 (HR: 0.79; 95% CI: 0.62 to 1.01; p = 0.061). Patients unable to walk 300 m or with a PAS ≤55 had higher mortality during the first 60 days with CABG (HR: 3.24; 95% CI: 1.64 to 6.83; p = 0.002) and no significant benefit from CABG during total follow-up (HR: 0.95; 95% CI: 0.75 to 1.19; p = 0.626; interaction p = 0.167). Conclusions: These observations suggest that patients with ischemic left ventricular dysfunction and poor exercise capacity have increased early risk and similar 5-year mortality with CABG compared with medical therapy, whereas those with better exercise capacity have improved survival with CABG. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH] NCT00023595).

Original languageEnglish (US)
Pages (from-to)335-343
Number of pages9
JournalJACC: Heart Failure
Volume2
Issue number4
DOIs
StatePublished - 2014

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Left Ventricular Dysfunction
Coronary Artery Bypass
Heart Failure
Exercise
Transplants
Mortality
Confidence Intervals
Therapeutics
Random Allocation
Dyspnea
Fatigue
Coronary Artery Disease
Survival

Keywords

  • Coronary disease
  • Heart failure
  • Surgery
  • Trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Exercise Capacity and Mortality in Patients With Ischemic Left Ventricular Dysfunction Randomized to Coronary Artery Bypass Graft Surgery or Medical Therapy. An Analysis From the STICH Trial (Surgical Treatment for Ischemic Heart Failure). / Stewart, Ralph A H; Szalewska, Dominika; She, Lilin; Lee, Kerry L.; Drazner, Mark H.; Lubiszewska, Barbara; Kosevic, Dragana; Ruengsakulrach, Permyos; Nicolau, José C.; Coutu, Benoit; Choudhary, Shiv K.; Mark, Daniel B.; Cleland, John G F; Pina, Ileana L.; Velazquez, Eric J.; Rynkiewicz, Andrzej; White, Harvey.

In: JACC: Heart Failure, Vol. 2, No. 4, 2014, p. 335-343.

Research output: Contribution to journalArticle

Stewart, RAH, Szalewska, D, She, L, Lee, KL, Drazner, MH, Lubiszewska, B, Kosevic, D, Ruengsakulrach, P, Nicolau, JC, Coutu, B, Choudhary, SK, Mark, DB, Cleland, JGF, Pina, IL, Velazquez, EJ, Rynkiewicz, A & White, H 2014, 'Exercise Capacity and Mortality in Patients With Ischemic Left Ventricular Dysfunction Randomized to Coronary Artery Bypass Graft Surgery or Medical Therapy. An Analysis From the STICH Trial (Surgical Treatment for Ischemic Heart Failure)', JACC: Heart Failure, vol. 2, no. 4, pp. 335-343. https://doi.org/10.1016/j.jchf.2014.02.009
Stewart, Ralph A H ; Szalewska, Dominika ; She, Lilin ; Lee, Kerry L. ; Drazner, Mark H. ; Lubiszewska, Barbara ; Kosevic, Dragana ; Ruengsakulrach, Permyos ; Nicolau, José C. ; Coutu, Benoit ; Choudhary, Shiv K. ; Mark, Daniel B. ; Cleland, John G F ; Pina, Ileana L. ; Velazquez, Eric J. ; Rynkiewicz, Andrzej ; White, Harvey. / Exercise Capacity and Mortality in Patients With Ischemic Left Ventricular Dysfunction Randomized to Coronary Artery Bypass Graft Surgery or Medical Therapy. An Analysis From the STICH Trial (Surgical Treatment for Ischemic Heart Failure). In: JACC: Heart Failure. 2014 ; Vol. 2, No. 4. pp. 335-343.
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abstract = "Objectives: The objective of this study was to assess the prognostic significance of exercise capacity in patients with ischemic left ventricular (LV) dysfunction eligible for coronary artery bypass graft surgery (CABG). Background: Poor exercise capacity is associated with mortality, but it is not known how this influences the benefits and risks of CABG compared with medical therapy. Methods: In an exploratory analysis, physical activity was assessed by questionnaire and 6-min walk test in 1,212 patients before randomization to CABG (n = 610) or medical management (n = 602) in the STICH (Surgical Treatment for Ischemic Heart Failure) trial. Mortality (n = 462) was compared by treatment allocation during 56 months (interquartile range: 48 to 68 months) of follow-up for subjects able (n = 682) and unable (n = 530) to walk 300 m in 6 min and with less (Physical Ability Score [PAS] >55, n = 749) and more (PAS ≤55, n = 433) limitation by dyspnea or fatigue. Results: Compared with medical therapy, mortality was lower for patients randomized to CABG who walked ≥300 m (hazard ratio [HR]: 0.77; 95{\%} confidence interval [CI]: 0.59 to 0.99; p = 0.038) and those with a PAS >55 (HR: 0.79; 95{\%} CI: 0.62 to 1.01; p = 0.061). Patients unable to walk 300 m or with a PAS ≤55 had higher mortality during the first 60 days with CABG (HR: 3.24; 95{\%} CI: 1.64 to 6.83; p = 0.002) and no significant benefit from CABG during total follow-up (HR: 0.95; 95{\%} CI: 0.75 to 1.19; p = 0.626; interaction p = 0.167). Conclusions: These observations suggest that patients with ischemic left ventricular dysfunction and poor exercise capacity have increased early risk and similar 5-year mortality with CABG compared with medical therapy, whereas those with better exercise capacity have improved survival with CABG. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH] NCT00023595).",
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T1 - Exercise Capacity and Mortality in Patients With Ischemic Left Ventricular Dysfunction Randomized to Coronary Artery Bypass Graft Surgery or Medical Therapy. An Analysis From the STICH Trial (Surgical Treatment for Ischemic Heart Failure)

AU - Stewart, Ralph A H

AU - Szalewska, Dominika

AU - She, Lilin

AU - Lee, Kerry L.

AU - Drazner, Mark H.

AU - Lubiszewska, Barbara

AU - Kosevic, Dragana

AU - Ruengsakulrach, Permyos

AU - Nicolau, José C.

AU - Coutu, Benoit

AU - Choudhary, Shiv K.

AU - Mark, Daniel B.

AU - Cleland, John G F

AU - Pina, Ileana L.

AU - Velazquez, Eric J.

AU - Rynkiewicz, Andrzej

AU - White, Harvey

PY - 2014

Y1 - 2014

N2 - Objectives: The objective of this study was to assess the prognostic significance of exercise capacity in patients with ischemic left ventricular (LV) dysfunction eligible for coronary artery bypass graft surgery (CABG). Background: Poor exercise capacity is associated with mortality, but it is not known how this influences the benefits and risks of CABG compared with medical therapy. Methods: In an exploratory analysis, physical activity was assessed by questionnaire and 6-min walk test in 1,212 patients before randomization to CABG (n = 610) or medical management (n = 602) in the STICH (Surgical Treatment for Ischemic Heart Failure) trial. Mortality (n = 462) was compared by treatment allocation during 56 months (interquartile range: 48 to 68 months) of follow-up for subjects able (n = 682) and unable (n = 530) to walk 300 m in 6 min and with less (Physical Ability Score [PAS] >55, n = 749) and more (PAS ≤55, n = 433) limitation by dyspnea or fatigue. Results: Compared with medical therapy, mortality was lower for patients randomized to CABG who walked ≥300 m (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.59 to 0.99; p = 0.038) and those with a PAS >55 (HR: 0.79; 95% CI: 0.62 to 1.01; p = 0.061). Patients unable to walk 300 m or with a PAS ≤55 had higher mortality during the first 60 days with CABG (HR: 3.24; 95% CI: 1.64 to 6.83; p = 0.002) and no significant benefit from CABG during total follow-up (HR: 0.95; 95% CI: 0.75 to 1.19; p = 0.626; interaction p = 0.167). Conclusions: These observations suggest that patients with ischemic left ventricular dysfunction and poor exercise capacity have increased early risk and similar 5-year mortality with CABG compared with medical therapy, whereas those with better exercise capacity have improved survival with CABG. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH] NCT00023595).

AB - Objectives: The objective of this study was to assess the prognostic significance of exercise capacity in patients with ischemic left ventricular (LV) dysfunction eligible for coronary artery bypass graft surgery (CABG). Background: Poor exercise capacity is associated with mortality, but it is not known how this influences the benefits and risks of CABG compared with medical therapy. Methods: In an exploratory analysis, physical activity was assessed by questionnaire and 6-min walk test in 1,212 patients before randomization to CABG (n = 610) or medical management (n = 602) in the STICH (Surgical Treatment for Ischemic Heart Failure) trial. Mortality (n = 462) was compared by treatment allocation during 56 months (interquartile range: 48 to 68 months) of follow-up for subjects able (n = 682) and unable (n = 530) to walk 300 m in 6 min and with less (Physical Ability Score [PAS] >55, n = 749) and more (PAS ≤55, n = 433) limitation by dyspnea or fatigue. Results: Compared with medical therapy, mortality was lower for patients randomized to CABG who walked ≥300 m (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.59 to 0.99; p = 0.038) and those with a PAS >55 (HR: 0.79; 95% CI: 0.62 to 1.01; p = 0.061). Patients unable to walk 300 m or with a PAS ≤55 had higher mortality during the first 60 days with CABG (HR: 3.24; 95% CI: 1.64 to 6.83; p = 0.002) and no significant benefit from CABG during total follow-up (HR: 0.95; 95% CI: 0.75 to 1.19; p = 0.626; interaction p = 0.167). Conclusions: These observations suggest that patients with ischemic left ventricular dysfunction and poor exercise capacity have increased early risk and similar 5-year mortality with CABG compared with medical therapy, whereas those with better exercise capacity have improved survival with CABG. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH] NCT00023595).

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KW - Heart failure

KW - Surgery

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