CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy

Howlett, Jonathan G.; Stebbins, Amanda; Petrie, Mark C.; Jhund, Pardeep S.; Castelvecchio, Serenella; Cherniavsky, Alexander; Roy, Ambuj; Piña, Ileana L.; Wurm, Raphael; Drazner, Mark H.; Andersson, Bert; Batlle, Carmen; Senni, Michele; Chrzanowski, Łukasz; Merkely, Béla; Carson, Peter E.; Desvigne‐Nickens, Patrice; Lee, Kerry L.; Velázquez, Eric J.; Al‐Khalidi, Hussein R.; Investigators, Stich Trial

doi:10.1016/j.jchf.2019.04.018

Cited by 59 publications

(35 citation statements)

References 28 publications

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“…7,8 Furthermore, a retrospective analysis showed significant reductions in first and recurrent all-cause, cardiovascular, and HF hospitalizations at 10 years in patients receiving CABG+ optimal medical therapy compared with optimal medical therapy alone. 2 Similar benefits from percutaneous coronary intervention revascularization, in this cohort, have not yet been shown in an RCT, although the REVIVED-BCIS2 (Study of Efficacy and Safety of Percutaneous Coronary Intervention to Improve Survival in Heart Failure) trial, which compares percutaneous coronary intervention with medical therapy in a similar population, is ongoing. 9 Recent data continue to show a benefit of CABG over percutaneous coronary intervention in patients with diabetes, CAD, and LV dysfunction and in patients with left main CAD and moderate or severe LV dysfunction.…”

Section: Stage C Hfmentioning

confidence: 62%

“…1,4,10–14 Long-term follow-up shows a reduction in all-cause, cardiovascular, and HF hospitalizations and in all-cause and cardiovascular mortality in patients with LV dysfunction who receive CABG and GDMT compared with GDMT alone. 2,7 The long-term survival benefit is greater in those with more advanced ischemic cardiomyopathy (lower EF or 3-vessel disease) and diminishes with increasing age. 5,7 CABG also improves QOL compared with GDMT alone.…”

Section: Stage C Hfmentioning

confidence: 99%

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2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

et al. 2022

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Aim: The “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” replaces the “2013 ACCF/AHA Guideline for the Management of Heart Failure” and the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.” The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. Methods: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients’ interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.

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Section: Stage C Hfmentioning

confidence: 62%

Section: Stage C Hfmentioning

confidence: 99%

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

et al. 2022

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“…Whereas the prognostic benefit from optimal medical therapy vs. that from revascularization in patients with stable coronary artery disease and angina is contentious, [ 18 , 137 ] it is particularly the group of patients with coronary artery disease and ischemic heart failure who benefit from coronary revascularization. In the STICH trial, 1212 patients with chronic coronary artery disease and a LV ejection fraction of ≤ 35% were randomized to medical treatment of surgical revascularization, and those with revascularization had better outcome in mortality, cardiovascular mortality and hospitalization for heart failure, [ 104 , 259 ] notwithstanding some critical considerations on the value of viability testing in this trial [ 5 ]. Also, in the otherwise neutral large ISCHEMIA trial, in 5179 patients with stable coronary artery disease and angina, it was the subgroup of 398 patients with a history of heart failure or LV ejection fraction ≥ 35 but < 45% who had a worse 4-year outcome than patients without heart failure or LV dysfunction.…”

Section: Heart Failure Of Ischemic Originmentioning

confidence: 99%

Coronary blood flow in heart failure: cause, consequence and bystander

Heusch

2022

Basic Res Cardiol

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Heart failure is a clinical syndrome where cardiac output is not sufficient to sustain adequate perfusion and normal bodily functions, initially during exercise and in more severe forms also at rest. The two most frequent forms are heart failure of ischemic origin and of non-ischemic origin. In heart failure of ischemic origin, reduced coronary blood flow is causal to cardiac contractile dysfunction, and this is true for stunned and hibernating myocardium, coronary microembolization, myocardial infarction and post-infarct remodeling, possibly also for the takotsubo syndrome. The most frequent form of non-ischemic heart failure is dilated cardiomyopathy, caused by genetic mutations, myocarditis, toxic agents or sustained tachyarrhythmias, where alterations in coronary blood flow result from and contribute to cardiac contractile dysfunction. Hypertrophic cardiomyopathy is caused by genetic mutations but can also result from increased pressure and volume overload (hypertension, valve disease). Heart failure with preserved ejection fraction is characterized by pronounced coronary microvascular dysfunction, the causal contribution of which is however not clear. The present review characterizes the alterations of coronary blood flow which are causes or consequences of heart failure in its different manifestations. Apart from any potentially accompanying coronary atherosclerosis, all heart failure entities share common features of impaired coronary blood flow, but to a different extent: enhanced extravascular compression, impaired nitric oxide-mediated, endothelium-dependent vasodilation and enhanced vasoconstriction to mediators of neurohumoral activation. Impaired coronary blood flow contributes to the progression of heart failure and is thus a valid target for established and novel treatment regimens.

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“…Surgical revascularization in addition to optimal medical therapy in patients with impaired left ventricular (LV) function (EF <= 35%) has been shown to reduce all-cause mortality compared to medical therapy alone. 35,36 Additionally, PCI in the setting of STEMI and concurrent cardiogenic shock has been shown to reduce long-term mortality. 37 However, performing PCI in patients with impaired LV function is associated with higher mortality rates, likely due to lack of myocardial reserve.…”

Section: Impaired Left Ventricular Function and Cardiogenic Shockmentioning

confidence: 99%