Pedro S Farsky1, Jennifer White2, Hussein R Al-Khalidi2, Carla A Sueta3, Jean L Rouleau4, Julio A Panza5, Eric J Velazquez6, Christopher M O'Connor7. 1. Instituto Dante Pazzanese de Cardiologia and Hospital Israelita Albert Einstein, Sao Paulo, Brazil. Electronic address: Pedro.farsky@gmail.com. 2. Duke Clinical Research Institute and Department of Biostatics and Bioinformatics, Duke University School of Medicine, Durham, NC. 3. Division of Cardiology, University of North Carolina, Chapel Hill, NC. 4. Department of Medicine, Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada. 5. Westchester Medical Center and New York Medical College, Valhalla, NY. 6. Department of Medicine, Yale University, New Haven, Conn. 7. Inova Heart and Vascular Institute, Fairfax, Va.
Abstract
OBJECTIVES: Optimal medical therapy in patients with heart failure and coronary artery disease is associated with improved outcomes. However, whether this association is influenced by the performance of coronary artery bypass grafting is less well established. Thus, the aim of this study was to determine the possible relationship between coronary artery bypass grafting and optimal medical therapy and its effect on the outcomes of patients with ischemic cardiomyopathy. METHODS: The Surgical Treatment for Ischemic Heart Failure trial randomized 1212 patients with coronary artery disease and left ventricular ejection fraction 35% or less to coronary artery bypass grafting with medical therapy or medical therapy alone with a median follow-up over 9.8 years. For the purpose of this study, optimal medical therapy was collected at baseline and 4 months, and defined as the combination of 4 drugs: angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, statin, and 1 antiplatelet drug. RESULTS: At baseline and 4 months, 58.7% and 73.3% of patients were receiving optimal medical therapy, respectively. These patients had no differences in important parameters such as left ventricular ejection fraction and left ventricular volumes. In a multivariable Cox model, optimal medical therapy at baseline was associated with a lower all-cause mortality (hazard ratio, 0.78; 95% confidence interval, 0.66-0.91; P = .001). When landmarked at 4 months, optimal medical therapy was also associated with a lower all-cause mortality (hazard ratio, 0.82; 95% confidence interval, 0.62-0.99; P = .04). There was no interaction between the benefit of optimal medical therapy and treatment allocation. CONCLUSIONS: Optimal medical therapy was associated with improved long-term survival and lower cardiovascular mortality in patients with ischemic cardiomyopathy and should be strongly recommended.
OBJECTIVES: Optimal medical therapy in patients with heart failure and coronary artery disease is associated with improved outcomes. However, whether this association is influenced by the performance of coronary artery bypass grafting is less well established. Thus, the aim of this study was to determine the possible relationship between coronary artery bypass grafting and optimal medical therapy and its effect on the outcomes of patients with ischemic cardiomyopathy. METHODS: The Surgical Treatment for Ischemic Heart Failure trial randomized 1212 patients with coronary artery disease and left ventricular ejection fraction 35% or less to coronary artery bypass grafting with medical therapy or medical therapy alone with a median follow-up over 9.8 years. For the purpose of this study, optimal medical therapy was collected at baseline and 4 months, and defined as the combination of 4 drugs: angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, statin, and 1 antiplatelet drug. RESULTS: At baseline and 4 months, 58.7% and 73.3% of patients were receiving optimal medical therapy, respectively. These patients had no differences in important parameters such as left ventricular ejection fraction and left ventricular volumes. In a multivariable Cox model, optimal medical therapy at baseline was associated with a lower all-cause mortality (hazard ratio, 0.78; 95% confidence interval, 0.66-0.91; P = .001). When landmarked at 4 months, optimal medical therapy was also associated with a lower all-cause mortality (hazard ratio, 0.82; 95% confidence interval, 0.62-0.99; P = .04). There was no interaction between the benefit of optimal medical therapy and treatment allocation. CONCLUSIONS: Optimal medical therapy was associated with improved long-term survival and lower cardiovascular mortality in patients with ischemic cardiomyopathy and should be strongly recommended.
Authors: Larry A Allen; Gregg C Fonarow; Li Liang; Phillip J Schulte; Frederick A Masoudi; John S Rumsfeld; P Michael Ho; Zubin J Eapen; Adrian F Hernandez; Paul A Heidenreich; Deepak L Bhatt; Eric D Peterson; Harlan M Krumholz Journal: Circulation Date: 2015-08-27 Impact factor: 29.690
Authors: Clyde W Yancy; Mariell Jessup; Biykem Bozkurt; Javed Butler; Donald E Casey; Mark H Drazner; Gregg C Fonarow; Stephen A Geraci; Tamara Horwich; James L Januzzi; Maryl R Johnson; Edward K Kasper; Wayne C Levy; Frederick A Masoudi; Patrick E McBride; John J V McMurray; Judith E Mitchell; Pamela N Peterson; Barbara Riegel; Flora Sam; Lynne W Stevenson; W H Wilson Tang; Emily J Tsai; Bruce L Wilkoff Journal: Circulation Date: 2013-06-05 Impact factor: 29.690
Authors: Dharam J Kumbhani; Ph Gabriel Steg; Christopher P Cannon; Kim A Eagle; Sidney C Smith; Elaine Hoffman; Shinya Goto; E Magnus Ohman; Deepak L Bhatt Journal: Am J Med Date: 2013-06-22 Impact factor: 4.965
Authors: Eric J Velazquez; Kerry L Lee; Marek A Deja; Anil Jain; George Sopko; Andrey Marchenko; Imtiaz S Ali; Gerald Pohost; Sinisa Gradinac; William T Abraham; Michael Yii; Dorairaj Prabhakaran; Hanna Szwed; Paolo Ferrazzi; Mark C Petrie; Christopher M O'Connor; Pradit Panchavinnin; Lilin She; Robert O Bonow; Gena Roush Rankin; Robert H Jones; Jean-Lucien Rouleau Journal: N Engl J Med Date: 2011-04-04 Impact factor: 91.245
Authors: James B Young; Mark E Dunlap; Marc A Pfeffer; Jeffrey L Probstfield; Alain Cohen-Solal; Rainer Dietz; Christopher B Granger; Jaromir Hradec; Jerzy Kuch; Robert S McKelvie; John J V McMurray; Eric L Michelson; Bertil Olofsson; Jan Ostergren; Peter Held; Scott D Solomon; Salim Yusuf; Karl Swedberg Journal: Circulation Date: 2004-10-18 Impact factor: 29.690
Authors: Mark A Hlatky; Matthew D Solomon; David Shilane; Thomas K Leong; Ralph Brindis; Alan S Go Journal: J Am Coll Cardiol Date: 2012-12-12 Impact factor: 24.094
Authors: Alexander Kulik; Raisa Levin; Marc Ruel; Thierry G Mesana; Daniel H Solomon; Niteesh K Choudhry Journal: J Thorac Cardiovasc Surg Date: 2007-10 Impact factor: 5.209