Heart failure & cardiomyopathies
Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction: An Analysis of the Extended Follow-Up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure)
Authors' conclusion
CABG added to MED has a more substantial benefit on all-cause mortality and the combination of all-cause mortality and cardiovascular hospitalization in younger compared with older patients. CABG added to MED has a consistent beneficial effect on cardiovascular mortality regardless of age.
Study context
- Population
- Patients with HF from ischemic cardiomyopathy, EF ≤35% and coronary disease amenable to coronary artery bypass grafting (CABG); age quartiles: Q1 ≤54, Q2 >54 and ≤60, Q3 >60 and ≤67, Q4 >67 years
- Participants
- 1,212 patients
- Comparison
- CABG vs MED, by age
- Primary endpoint
- Effect of CABG vs MED on all-cause mortality, CV mortality, and all-cause mortality or CV hospitalization, by age
- Follow-up
- Median 9.8 years
Methodological detailssubgroup analysis by age quartiles
- Subgroup analysis by age quartiles
Primary result
As reported in the abstract
All-cause mortality by age quartile (Q4 vs Q1)
Q4
Q1
- Higher all-cause mortality in older vs younger patients, MED (log-rank)
- P = 0.005
- Higher all-cause mortality in older vs younger patients, CABG (log-rank)
- P < 0.001
- Effect of CABG vs MED on all-cause mortality tended to diminish with increasing age
- P for interaction = 0.062
- Benefit of CABG on CV mortality consistent over all ages
- P for interaction = 0.307
- Greater reduction in all-cause mortality or CV hospitalization with CABG vs MED in younger vs older patients
- P for interaction = 0.004
Further findings
CV mortality by age quartile (Q4 vs Q1)
Q4
Q1
- CV mortality by age quartile (Q4 vs Q1) — Not significantly different across age, MED (log-rank)
- P=0.388
- CV mortality by age quartile (Q4 vs Q1) — Not significantly different across age, CABG (log-rank)
- P=0.103
CV deaths as proportion of deaths, youngest vs oldest quartile
- Youngest quartile
- 79%
- Oldest quartile
- 62%
Safety
Cardiopulmonary bypass time, ICU days (CABG, older vs younger)
- Did not differ for older vs younger patients
Original publication
Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction: An Analysis of the Extended Follow-Up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure). Circulation. Published 29 August 2016. doi:10.
Summarised from the published abstract; every number is checked against it