Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction

Abstract

Background Advancing age is associated with a greater prevalence of coronary artery disease in heart failure (HF) with reduced ejection fraction and with a higher risk of complications following coronary artery bypass grafting (CABG). Whether the efficacy of CABG compared with medical therapy (MED) in patients with HF due to ischemic cardiomyopathy is the same in patients of different age is unknown. Methods 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. Results Mean age at trial entry was 60 years; 12% women; 36% non-white; baseline EF 28%. For the present analyses, patients were categorized by age quartiles: Q1 ≤54 years, Q2 >54 and ≤60 years, Q3 >60 and ≤67 years, Q4 >67 years. Older vs. younger patients had more comorbidities. All-cause mortality was higher in older compared with younger patients assigned to MED (79 vs. 60% for Q4 and Q1, respectively; log-rank p=0.005) and CABG (68 vs. 48% for Q4 and Q1, respectively; log-rank p<0.001). In contrast, CV mortality was not statistically significantly different across the spectrum of age in the MED group (53 vs. 49% for Q4 and Q1, respectively; log-rank p=0.388) or CABG group (39 vs 35% for Q4 and Q1, respectively; log-rank p=0.103). CV deaths accounted for a greater proportion of deaths in the youngest vs oldest quartile (79% vs 62%). The effect of CABG vs MED on all-cause mortality tended to diminish with increasing age (pinteraction=0.062), while the benefit of CABG on CV mortality was consistent over all ages (pinteraction =0.307). There was a greater reduction in all-cause mortality or CV 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 vs. younger patients. Conclusions CABG added to MED has a more substantial benefit on all-cause mortality and all-cause mortality and CV hospitalization in younger compared to older patients. CABG added to MED has a consistent beneficial effect on CV mortality regardless of age.

A Peripheral Blood Transcriptome Biomarker Test to Diagnose Functional Recovery Potential in Advanced Heart Failure

“…In the Surgical Treatment for Ischemic Heart Failure Extended Study trial, the median duration of follow-up was 9.8 years. There was a trend toward a smaller reduction in all-cause mortality with CABG compared with GDMT in older compared with younger patients, implying that an improved understanding of the efficacy of CABG in different age groups is needed [13,16]. This result is consistent with recent HF trials [11].…”

“…The benefits or harms of percutaneous coronary intervention in populations with AdHF are unknown because of a lack of randomized trials date [13].…”

Double-Blind, Randomized, Placebo-Controlled Trial Evaluating the Efficacy and Safety of Eplerenone in Japanese Patients With Chronic Heart Failure (J-EMPHASIS-HF)

“…The incidence of any adverse event was comparable between the eplerenone and placebo groups (91.9% and 93.6%, respectively) intervention ( Table 1). Revascularization has short-term and long-term mortality benefits, 16 which might have contributed to better survival in the placebo group. Also, 5 patients with LVEF ≤15% were enrolled in this study, all of whom were randomized to the eplerenone group and 2 of whom died.…”

De-programming colorectal cancer by increase in cholesterol level

“…This superfood is possible include in salads and on burgers as a preventive measure, onion extract will be added to food products such as juice or baked goods and be sold in pill form as a type of natural cancer treatment! [8,9].…”