TY - JOUR
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.
N1 - Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/9/15
Y1 - 2019/9/15
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;
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;
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
DO - 10.1016/j.ijcard.2019.03.029
M3 - Article
C2 - 30929973
AN - SCOPUS:85063513854
SN - 0167-5273
VL - 291
SP - 36
EP - 41
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -