title: 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).
abstract: BACKGROUND
  Advancing age is associated with a greater prevalence of coronary artery disease in heart failure with reduced ejection fraction and with a higher risk of complications after coronary artery bypass grafting (CABG). Whether the efficacy of CABG compared with medical therapy (MED) in patients with heart failure caused by ischemic cardiomyopathy is the same in patients of different ages is unknown.
  
  
  METHODS
  A total of 1212 patients (median follow-up, 9.8 years) with ejection fraction ≤35% and coronary disease amenable to CABG were randomized to CABG or MED in the STICH trial (Surgical Treatment for Ischemic Heart Failure).
  
  
  RESULTS
  Mean age at trial entry was 60 years; 12% were women; 36% were nonwhite; and the baseline ejection fraction was 28%. For the present analyses, patients were categorized by age quartiles: quartile 1, ≤54 years; quartile, 2 >54 and ≤60 years; quartile 3, >60 and ≤67 years; and quartile 4, >67 years. Older versus younger patients had more comorbidities. All-cause mortality was higher in older compared with younger patients assigned to MED (79% versus 60% for quartiles 4 and 1, respectively; log-rank P=0.005) and CABG (68% versus 48% for quartiles 4 and 1, respectively; log-rank P<0.001). In contrast, cardiovascular mortality was not statistically significantly different across the spectrum of age in the MED group (53% versus 49% for quartiles 4 and 1, respectively; log-rank P=0.388) or CABG group (39% versus 35% for quartiles 4 and 1, respectively; log-rank P=0.103). Cardiovascular deaths accounted for a greater proportion of deaths in the youngest versus oldest quartile (79% versus 62%). The effect of CABG versus MED on all-cause mortality tended to diminish with increasing age (Pinteraction=0.062), whereas the benefit of CABG on cardiovascular mortality was consistent over all ages (Pinteraction=0.307). There was a greater reduction in all-cause mortality or cardiovascular hospitalization with CABG versus MED in younger compared with older patients (Pinteraction=0.004). In the CABG group, cardiopulmonary bypass time or days in intensive care did not differ for older versus younger patients.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.
authors: BHF GCRC, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Mark C
authors: MC
authors: Petrie
authors: BHF GCRC, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Pardeep S
authors: PS
authors: Jhund
authors: Duke Clinical Research Institute and Departments of Biostatistics and Bioinformatics (KLL) and Medicine (EJV), Duke University School of Medicine, Durham, North Carolina, USA.
authors: Lilin
authors: L
authors: She
authors: Department of Medicine II, Division of Cardiology, Medical University of Vienna and 4 Medical Department, Hietzing Hospital, Vienna, Austria.
authors: Christopher
authors: C
authors: Adlbrecht
authors: Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller University of Jena, Germany.
authors: Torsten
authors: T
authors: Doenst
authors: Westchester Medical Center and New York Medical College, Valhalla, New York, USA.
authors: Julio A
authors: JA
authors: Panza
authors: University of Florida, Gainesville, USA.
authors: James A
authors: JA
authors: Hill
authors: Duke Clinical Research Institute and Departments of Biostatistics and Bioinformatics (KLL) and Medicine (EJV), Duke University School of Medicine, Durham, North Carolina, USA.
authors: Kerry L
authors: KL
authors: Lee
authors: University of Montreal, Montreal Heart Institute, Montreal, Canada.
authors: Jean L
authors: JL
authors: Rouleau
authors: Department of Cardiology, St. Vincent's Hospital, University of Melbourne, Australia.
authors: David L
authors: DL
authors: Prior
authors: Libin Cardiovascular Institute of Alberta, University of Calgary, Canada.
authors: Imtiaz S
authors: IS
authors: Ali
authors: Department of Cardiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India.
authors: Jyotsna
authors: J
authors: Maddury
authors: Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland.
authors: Krzysztof S
authors: KS
authors: Golba
authors: Auckland City Hospital Greenlane Cardiovascular Services, Auckland, New Zealand.
authors: Harvey D
authors: HD
authors: White
authors: Washington, DC VA Medical Center, USA.
authors: Peter
authors: P
authors: Carson
authors: Department of Cardiology, Medical University of Lodz, Poland.
authors: Lukasz
authors: L
authors: Chrzanowski
authors: Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors: Alexander
authors: A
authors: Romanov
authors: Department of Cardiology, University of Florida, Jacksonville, USA.
authors: Alan B
authors: AB
authors: Miller
authors: Duke Clinical Research Institute and Departments of Biostatistics and Bioinformatics (KLL) and Medicine (EJV), Duke University School of Medicine, Durham, North Carolina, USA.
authors: Eric J
authors: EJ
authors: Velazquez
mesh_terms: D000367:Age Factors; D000368:Aged; D001026:Coronary Artery Bypass; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D013318:Stroke Volume; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000601:surgery
keywords: aging; coronary artery bypass; coronary artery disease; heart failure