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)

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorSTEWART, Ralph A. H.
dc.contributor.authorSZALEWSKA, Dominika
dc.contributor.authorSHE, Lilin
dc.contributor.authorLEE, Kerry L.
dc.contributor.authorDRAZNER, Mark H.
dc.contributor.authorLUBISZEWSKA, Barbara
dc.contributor.authorKOSEVIC, Dragana
dc.contributor.authorRUENGSAKULRACH, Permyos
dc.contributor.authorNICOLAU, Jose C.
dc.contributor.authorCOUTU, Benoit
dc.contributor.authorCHOUDHARY, Shiv K.
dc.contributor.authorMARK, Daniel B.
dc.contributor.authorCLELAND, John G. F.
dc.contributor.authorPINA, Ileana L.
dc.contributor.authorVELAZQUEZ, Eric J.
dc.contributor.authorRYNKIEWICZ, Andrzej
dc.contributor.authorWHITE, Harvey
dc.date.accessioned2016-02-11T14:05:44Z
dc.date.available2016-02-11T14:05:44Z
dc.date.issued2014
dc.description.abstractOBJECTIVES 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) (C) 2014 by the American College of Cardiology Foundation.
dc.description.indexMEDLINE
dc.description.sponsorshipNational Heart, Lung, and Blood Institute [U01HL69015, U01HL69013]
dc.description.sponsorshipSanofi
dc.description.sponsorshipGlaxoSmithKline
dc.description.sponsorshipBayer
dc.description.sponsorshipNovartis
dc.description.sponsorshipDaiichi-Sankyo
dc.description.sponsorshipAstraZeneca
dc.description.sponsorshipBristol-Myers Squibb
dc.description.sponsorshipAmgen
dc.description.sponsorshipBoehringer Ingelheim
dc.description.sponsorshipPfizer Inc.
dc.description.sponsorshipServier
dc.description.sponsorshipSanofi-Aventis
dc.description.sponsorshipEli Lilly
dc.description.sponsorshipMedicines Company/National Institutes of Health
dc.description.sponsorshipRoche
dc.description.sponsorshipJohnson Johnson
dc.description.sponsorshipSchering-Plough
dc.description.sponsorshipMerck Sharpe Dohme
dc.description.sponsorshipDaiichi Sankyo Pharma Development
dc.identifier.citationJACC-HEART FAILURE, v.2, n.4, p.335-343, 2014
dc.identifier.doi10.1016/j.jchf.2014.02.009
dc.identifier.eissn2213-1787
dc.identifier.issn2213-1779
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/12660
dc.language.isoeng
dc.publisherELSEVIER SCI LTD
dc.relation.ispartofJacc-Heart Failure
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER SCI LTD
dc.subjectcoronary disease
dc.subjectheart failure
dc.subjectsurgery
dc.subjecttrials
dc.subject.other6-minute walk test
dc.subject.otherquality-of-life
dc.subject.othercardiac-surgery
dc.subject.otherprognostic value
dc.subject.othergait speed
dc.subject.otherdisease
dc.subject.othersurvival
dc.subject.otherrisk
dc.subject.otherassociation
dc.subject.otherdisability
dc.subject.wosCardiac & Cardiovascular Systems
dc.titleExercise 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)
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryNova Zelândia
hcfmusp.affiliation.countryInglaterra
hcfmusp.affiliation.countryÍndia
hcfmusp.affiliation.countryCanadá
hcfmusp.affiliation.countryTailândia
hcfmusp.affiliation.countrySérvia
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryPolônia
hcfmusp.affiliation.countryisonz
hcfmusp.affiliation.countryisopl
hcfmusp.affiliation.countryisous
hcfmusp.affiliation.countryisors
hcfmusp.affiliation.countryisoth
hcfmusp.affiliation.countryisoca
hcfmusp.affiliation.countryisoin
hcfmusp.affiliation.countryisogb
hcfmusp.author.externalSTEWART, Ralph A. H.:Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland 1142, New Zealand; Univ Auckland, Auckland 1, New Zealand
hcfmusp.author.externalSZALEWSKA, Dominika:Med Univ Gdansk, Dept Rehabil, Gdansk, Poland
hcfmusp.author.externalSHE, Lilin:Clin Trial Biostat, Duke Clin Res Inst, Durham, NC USA
hcfmusp.author.externalLEE, Kerry L.:Duke Univ, Sch Med, Dept Biostat & Bioinformat, Duke Clin Res Inst, Durham, NC USA
hcfmusp.author.externalDRAZNER, Mark H.:Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA
hcfmusp.author.externalLUBISZEWSKA, Barbara:Natl Inst Cardiol, Warsaw, Poland
hcfmusp.author.externalKOSEVIC, Dragana:Dedinje Cardiovasc Inst, Belgrade, Serbia
hcfmusp.author.externalRUENGSAKULRACH, Permyos:Bangkok Heart Hosp, Bangkok Hosp Grp, Bangkok, Thailand
hcfmusp.author.externalCOUTU, Benoit:CHUM, Hotel Dieu, Montreal, PQ, Canada
hcfmusp.author.externalCHOUDHARY, Shiv K.:All India Inst Med Sci, New Delhi, India
hcfmusp.author.externalMARK, Daniel B.:Duke Univ, Sch Med, Dept Med Cardiol, Duke Clin Res Inst, Durham, NC USA
hcfmusp.author.externalCLELAND, John G. F.:Castle Hill Hosp, Hull Royal Infirm, Kingston Upon Hull, Yorks, England
hcfmusp.author.externalPINA, Ileana L.:Montefiore Med Ctr, Albert Einstein Coll Med, New York, NY USA
hcfmusp.author.externalVELAZQUEZ, Eric J.:Duke Univ, Sch Med, Dept Med Cardiol, Duke Clin Res Inst, Durham, NC USA
hcfmusp.author.externalRYNKIEWICZ, Andrzej:Univ Waria & Mazury, Dept Cardiol & Cardiosurg, Olsztyn, Poland
hcfmusp.author.externalWHITE, Harvey:Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland 1142, New Zealand; Univ Auckland, Auckland 1, New Zealand
hcfmusp.citation.scopus40
hcfmusp.contributor.author-fmusphcJOSE CARLOS NICOLAU
hcfmusp.description.beginpage335
hcfmusp.description.endpage343
hcfmusp.description.issue4
hcfmusp.description.volume2
hcfmusp.origemWOS
hcfmusp.origem.pubmed25023813
hcfmusp.origem.scopus2-s2.0-84905438905
hcfmusp.origem.wosWOS:000365648100003
hcfmusp.publisher.cityOXFORD
hcfmusp.publisher.countryENGLAND
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