Sex difference in patients with ischemic heart failure undergoing surgical revascularization results from the STICH trial (surgical treatment for ischemic heart failure)

Ileana L. Pina, Qi Zheng, Lilin She, Hanna Szwed, Irene M. Lang, Pedro S. Farsky, Serenella Castelvecchio, Jolanta Biernat, Alexandros Paraforos, Dragana Kosevic, Liliana E. Favaloro, José C. Nicolau, Padmini Varadarajan, Eric J. Velazquez, Ramdas G. Pai, Nicole Cyrille, Kerry L. Lee, Patrice Desvigne-Nickens

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: Female sex is conventionally considered a risk factor for coronary artery bypass grafting (CABG) and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We aimed to investigate the association of sex and the long-term beneft of CABG in patients with ischemic left ventricular dysfunction enrolled in the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure Study). METHODS: The STICH trial randomized 1212 patients (148 [12%] women and 1064 [88%] men) with coronary artery disease and left ventricular ejection fraction =35% to CABG+medical therapy (MED) versus MED alone. Long-term (10-year) outcomes with each treatment were compared according to sex. RESULTS: At baseline, women were older (63.4 versus 59.3 years; P=0.016) with higher body mass index (27.9 versus 26.7 kg/m2; P=0.001). Women had more coronary artery disease risk factors (diabetes mellitus, 55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia, 70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower rates of prior CABG (0% versus 3.4%; all P<0.05) than men. Moreover, women had higher New York Heart Association class (class III/IV, 66.2% versus 57.0%), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas City Cardiomyopathy Questionnaire overall summary scores (51 versus 63; all P<0.05). Over 10 years of followup, all-cause mortality (49.0% versus 65.8%; adjusted hazard ratio, 0.67; 95% confdence interval, 0.52-0.86; P=0.002) and cardiovascular mortality (34.3% versus 52.3%; adjusted hazard ratio, 0.65; 95% confdence interval, 0.48-0.89; P=0.006) were signifcantly lower in women compared with men. With randomization to CABG+MED versus MED treatment, there was no signifcant interaction between sex and treatment group in all-cause mortality, cardiovascular mortality, or the composite of all-cause mortality or cardiovascular hospitalization (all P>0.05). In addition, surgical deaths were not statistically different (1.5% versus 5.1%; P=0.187) between sexes among patients randomized to CABG per protocol as initial treatment. CONCLUSIONS: Sex is not associated with the effect of CABG+MED versus MED on all-cause mortality, cardiovascular mortality, the composite of death or cardiovascular hospitalization, or surgical deaths in patients with ischemic left ventricular dysfunction. Thus, sex should not influence treatment decisions about CABG in these patients.

Original languageEnglish (US)
Pages (from-to)771-780
Number of pages10
JournalCirculation
Volume137
Issue number8
DOIs
StatePublished - Jan 1 2018

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Sex Characteristics
Coronary Artery Bypass
Heart Failure
Left Ventricular Dysfunction
Therapeutics
Coronary Artery Disease
Mortality
Hyperlipidemias
Stroke Volume
Diabetes Mellitus
Hospitalization
Body Mass Index
Smoking
Hypertension

Keywords

  • Coronary artery bypass
  • Heart failure
  • Women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Sex difference in patients with ischemic heart failure undergoing surgical revascularization results from the STICH trial (surgical treatment for ischemic heart failure). / Pina, Ileana L.; Zheng, Qi; She, Lilin; Szwed, Hanna; Lang, Irene M.; Farsky, Pedro S.; Castelvecchio, Serenella; Biernat, Jolanta; Paraforos, Alexandros; Kosevic, Dragana; Favaloro, Liliana E.; Nicolau, José C.; Varadarajan, Padmini; Velazquez, Eric J.; Pai, Ramdas G.; Cyrille, Nicole; Lee, Kerry L.; Desvigne-Nickens, Patrice.

In: Circulation, Vol. 137, No. 8, 01.01.2018, p. 771-780.

Research output: Contribution to journalArticle

Pina, IL, Zheng, Q, She, L, Szwed, H, Lang, IM, Farsky, PS, Castelvecchio, S, Biernat, J, Paraforos, A, Kosevic, D, Favaloro, LE, Nicolau, JC, Varadarajan, P, Velazquez, EJ, Pai, RG, Cyrille, N, Lee, KL & Desvigne-Nickens, P 2018, 'Sex difference in patients with ischemic heart failure undergoing surgical revascularization results from the STICH trial (surgical treatment for ischemic heart failure)', Circulation, vol. 137, no. 8, pp. 771-780. https://doi.org/10.1161/CIRCULATIONAHA.117.030526
Pina, Ileana L. ; Zheng, Qi ; She, Lilin ; Szwed, Hanna ; Lang, Irene M. ; Farsky, Pedro S. ; Castelvecchio, Serenella ; Biernat, Jolanta ; Paraforos, Alexandros ; Kosevic, Dragana ; Favaloro, Liliana E. ; Nicolau, José C. ; Varadarajan, Padmini ; Velazquez, Eric J. ; Pai, Ramdas G. ; Cyrille, Nicole ; Lee, Kerry L. ; Desvigne-Nickens, Patrice. / Sex difference in patients with ischemic heart failure undergoing surgical revascularization results from the STICH trial (surgical treatment for ischemic heart failure). In: Circulation. 2018 ; Vol. 137, No. 8. pp. 771-780.
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abstract = "BACKGROUND: Female sex is conventionally considered a risk factor for coronary artery bypass grafting (CABG) and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We aimed to investigate the association of sex and the long-term beneft of CABG in patients with ischemic left ventricular dysfunction enrolled in the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure Study). METHODS: The STICH trial randomized 1212 patients (148 [12{\%}] women and 1064 [88{\%}] men) with coronary artery disease and left ventricular ejection fraction =35{\%} to CABG+medical therapy (MED) versus MED alone. Long-term (10-year) outcomes with each treatment were compared according to sex. RESULTS: At baseline, women were older (63.4 versus 59.3 years; P=0.016) with higher body mass index (27.9 versus 26.7 kg/m2; P=0.001). Women had more coronary artery disease risk factors (diabetes mellitus, 55.4{\%} versus 37.2{\%}; hypertension, 70.9{\%} versus 58.6{\%}; hyperlipidemia, 70.3{\%} versus 58.9{\%}) except for smoking (13.5{\%} versus 21.8{\%}) and had lower rates of prior CABG (0{\%} versus 3.4{\%}; all P<0.05) than men. Moreover, women had higher New York Heart Association class (class III/IV, 66.2{\%} versus 57.0{\%}), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas City Cardiomyopathy Questionnaire overall summary scores (51 versus 63; all P<0.05). Over 10 years of followup, all-cause mortality (49.0{\%} versus 65.8{\%}; adjusted hazard ratio, 0.67; 95{\%} confdence interval, 0.52-0.86; P=0.002) and cardiovascular mortality (34.3{\%} versus 52.3{\%}; adjusted hazard ratio, 0.65; 95{\%} confdence interval, 0.48-0.89; P=0.006) were signifcantly lower in women compared with men. With randomization to CABG+MED versus MED treatment, there was no signifcant interaction between sex and treatment group in all-cause mortality, cardiovascular mortality, or the composite of all-cause mortality or cardiovascular hospitalization (all P>0.05). In addition, surgical deaths were not statistically different (1.5{\%} versus 5.1{\%}; P=0.187) between sexes among patients randomized to CABG per protocol as initial treatment. CONCLUSIONS: Sex is not associated with the effect of CABG+MED versus MED on all-cause mortality, cardiovascular mortality, the composite of death or cardiovascular hospitalization, or surgical deaths in patients with ischemic left ventricular dysfunction. Thus, sex should not influence treatment decisions about CABG in these patients.",
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TY - JOUR

T1 - Sex difference in patients with ischemic heart failure undergoing surgical revascularization results from the STICH trial (surgical treatment for ischemic heart failure)

AU - Pina, Ileana L.

AU - Zheng, Qi

AU - She, Lilin

AU - Szwed, Hanna

AU - Lang, Irene M.

AU - Farsky, Pedro S.

AU - Castelvecchio, Serenella

AU - Biernat, Jolanta

AU - Paraforos, Alexandros

AU - Kosevic, Dragana

AU - Favaloro, Liliana E.

AU - Nicolau, José C.

AU - Varadarajan, Padmini

AU - Velazquez, Eric J.

AU - Pai, Ramdas G.

AU - Cyrille, Nicole

AU - Lee, Kerry L.

AU - Desvigne-Nickens, Patrice

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: Female sex is conventionally considered a risk factor for coronary artery bypass grafting (CABG) and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We aimed to investigate the association of sex and the long-term beneft of CABG in patients with ischemic left ventricular dysfunction enrolled in the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure Study). METHODS: The STICH trial randomized 1212 patients (148 [12%] women and 1064 [88%] men) with coronary artery disease and left ventricular ejection fraction =35% to CABG+medical therapy (MED) versus MED alone. Long-term (10-year) outcomes with each treatment were compared according to sex. RESULTS: At baseline, women were older (63.4 versus 59.3 years; P=0.016) with higher body mass index (27.9 versus 26.7 kg/m2; P=0.001). Women had more coronary artery disease risk factors (diabetes mellitus, 55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia, 70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower rates of prior CABG (0% versus 3.4%; all P<0.05) than men. Moreover, women had higher New York Heart Association class (class III/IV, 66.2% versus 57.0%), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas City Cardiomyopathy Questionnaire overall summary scores (51 versus 63; all P<0.05). Over 10 years of followup, all-cause mortality (49.0% versus 65.8%; adjusted hazard ratio, 0.67; 95% confdence interval, 0.52-0.86; P=0.002) and cardiovascular mortality (34.3% versus 52.3%; adjusted hazard ratio, 0.65; 95% confdence interval, 0.48-0.89; P=0.006) were signifcantly lower in women compared with men. With randomization to CABG+MED versus MED treatment, there was no signifcant interaction between sex and treatment group in all-cause mortality, cardiovascular mortality, or the composite of all-cause mortality or cardiovascular hospitalization (all P>0.05). In addition, surgical deaths were not statistically different (1.5% versus 5.1%; P=0.187) between sexes among patients randomized to CABG per protocol as initial treatment. CONCLUSIONS: Sex is not associated with the effect of CABG+MED versus MED on all-cause mortality, cardiovascular mortality, the composite of death or cardiovascular hospitalization, or surgical deaths in patients with ischemic left ventricular dysfunction. Thus, sex should not influence treatment decisions about CABG in these patients.

AB - BACKGROUND: Female sex is conventionally considered a risk factor for coronary artery bypass grafting (CABG) and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We aimed to investigate the association of sex and the long-term beneft of CABG in patients with ischemic left ventricular dysfunction enrolled in the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure Study). METHODS: The STICH trial randomized 1212 patients (148 [12%] women and 1064 [88%] men) with coronary artery disease and left ventricular ejection fraction =35% to CABG+medical therapy (MED) versus MED alone. Long-term (10-year) outcomes with each treatment were compared according to sex. RESULTS: At baseline, women were older (63.4 versus 59.3 years; P=0.016) with higher body mass index (27.9 versus 26.7 kg/m2; P=0.001). Women had more coronary artery disease risk factors (diabetes mellitus, 55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia, 70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower rates of prior CABG (0% versus 3.4%; all P<0.05) than men. Moreover, women had higher New York Heart Association class (class III/IV, 66.2% versus 57.0%), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas City Cardiomyopathy Questionnaire overall summary scores (51 versus 63; all P<0.05). Over 10 years of followup, all-cause mortality (49.0% versus 65.8%; adjusted hazard ratio, 0.67; 95% confdence interval, 0.52-0.86; P=0.002) and cardiovascular mortality (34.3% versus 52.3%; adjusted hazard ratio, 0.65; 95% confdence interval, 0.48-0.89; P=0.006) were signifcantly lower in women compared with men. With randomization to CABG+MED versus MED treatment, there was no signifcant interaction between sex and treatment group in all-cause mortality, cardiovascular mortality, or the composite of all-cause mortality or cardiovascular hospitalization (all P>0.05). In addition, surgical deaths were not statistically different (1.5% versus 5.1%; P=0.187) between sexes among patients randomized to CABG per protocol as initial treatment. CONCLUSIONS: Sex is not associated with the effect of CABG+MED versus MED on all-cause mortality, cardiovascular mortality, the composite of death or cardiovascular hospitalization, or surgical deaths in patients with ischemic left ventricular dysfunction. Thus, sex should not influence treatment decisions about CABG in these patients.

KW - Coronary artery bypass

KW - Heart failure

KW - Women

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