Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial.
Aged
Angioplasty
/ mortality
Coronary Artery Bypass
/ mortality
Coronary Artery Disease
/ diagnostic imaging
Female
Follow-Up Studies
Humans
Male
Middle Aged
Mortality
/ trends
Myocardial Revascularization
/ mortality
Percutaneous Coronary Intervention
/ mortality
Prospective Studies
Stroke Volume
/ physiology
Ventricular Dysfunction, Left
/ diagnostic imaging
Coronary artery bypass surgery
Heart failure
Left ventricular dysfunction
Percutaneous coronary intervention
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
15 09 2019
15 09 2019
Historique:
received:
28
01
2019
revised:
25
02
2019
accepted:
14
03
2019
pubmed:
2
4
2019
medline:
15
5
2020
entrez:
2
4
2019
Statut:
ppublish
Résumé
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. The main purpose of this study was to analyse if prior PCI influenced outcomes in STICH. 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). 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. Clinicaltrials.gov; Identifier: NCT00023595.
Sections du résumé
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.
Identifiants
pubmed: 30929973
pii: S0167-5273(19)30541-8
doi: 10.1016/j.ijcard.2019.03.029
pmc: PMC6579621
mid: NIHMS1525848
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT00023595']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
36-41Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL105853
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL069013
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL069015
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.
Références
Eur J Cardiothorac Surg. 2019 Feb 1;55(2):186-190
pubmed: 30388217
Surgery. 2012 Jul;152(1):5-11
pubmed: 22503323
J Am Coll Cardiol. 2017 May 2;69(17):2212-2241
pubmed: 28291663
Heart Lung Circ. 2013 Nov;22(11):940-5
pubmed: 23683716
Circulation. 2006 Jul 4;114(1 Suppl):I441-7
pubmed: 16820616
Circ Cardiovasc Interv. 2018 Feb;11(2):e005650
pubmed: 29440275
N Engl J Med. 1985 Jun 27;312(26):1665-71
pubmed: 3873614
Eur Heart J. 2014 Oct 1;35(37):2541-619
pubmed: 25173339
N Engl J Med. 2009 Mar 5;360(10):961-72
pubmed: 19228612
J Thorac Cardiovasc Surg. 2007 Dec;134(6):1540-7
pubmed: 18023680
J Thorac Cardiovasc Surg. 2015 May;149(5):1302-9
pubmed: 25772280
N Engl J Med. 1984 Nov 22;311(21):1333-9
pubmed: 6333636
Heart Vessels. 2016 Apr;31(4):457-64
pubmed: 25637043
Lancet. 2003 Jan 4;361(9351):13-20
pubmed: 12517460
Eur J Cardiothorac Surg. 2011 Jun;39(6):e164-9
pubmed: 21459592
Am J Cardiol. 2017 Jul 1;120(1):69-74
pubmed: 28483202
Eur Heart J. 2008 Mar;29(5):673-9
pubmed: 18285358
Ann Thorac Surg. 2017 Jul;104(1):56-61
pubmed: 28131427
Ann Thorac Surg. 2012 Jun;93(6):1956-62
pubmed: 22520830
N Engl J Med. 2011 Apr 28;364(17):1607-16
pubmed: 21463150
Ann Thorac Surg. 2016 Dec;102(6):1911-1918
pubmed: 27743636
Circulation. 2016 May 31;133(22):2132-40
pubmed: 27151532
Arq Bras Cardiol. 2012 Jul;99(1):586-95
pubmed: 22735865
N Engl J Med. 2016 Apr 21;374(16):1511-20
pubmed: 27040723
Circ Heart Fail. 2017 Jan;10(1):
pubmed: 28087687
Am Heart J. 2005 Nov;150(5):1026-31
pubmed: 16290991
J Card Surg. 2015 Apr;30(4):313-8
pubmed: 25644217