Optimal Medical Therapy With or Without Surgical Revascularization and Long-Term Outcomes in Ischemic Cardiomyopathy

Authors

Pedro S. Farsky, Instituto Dante Pazzanese de Cardiologia and Hospital Israelita Albert Einstein, Sao Paulo, Brazil. Electronic address: Pedro.farsky@gmail.com.
Jennifer White, Duke Clinical Research Institute and Department of Biostatics and Bioinformatics, Duke University School of Medicine, Durham, NC.
Hussein R. Al-Khalidi, Duke Clinical Research Institute and Department of Biostatics and Bioinformatics, Duke University School of Medicine, Durham, NC.Follow
Carla A. Sueta, Division of Cardiology, University of North Carolina, Chapel Hill, NC.
Jean L. Rouleau, Department of Medicine, Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada.
Julio A. Panza, Westchester Medical Center and New York Medical College, Valhalla, NY.Follow
Eric J. Velazquez, Department of Medicine, Yale University, New Haven, Conn.
Christopher M. O'Connor, Inova Heart and Vascular Institute, Fairfax, Va.

Author Type(s)

Faculty

DOI

10.1016/j.jtcvs.2020.12.094

Journal Title

The Journal of Thoracic and Cardiovascular Surgery

First Page

1890

Last Page

1899.e4

Document Type

Article

Publication Date

12-1-2022

Department

Medicine

Abstract

OBJECTIVES: Optimal medical therapy in patients with heart failure and coronary artery disease is associated with improved outcomes. However, whether this association is influenced by the performance of coronary artery bypass grafting is less well established. Thus, the aim of this study was to determine the possible relationship between coronary artery bypass grafting and optimal medical therapy and its effect on the outcomes of patients with ischemic cardiomyopathy. METHODS: The Surgical Treatment for Ischemic Heart Failure trial randomized 1212 patients with coronary artery disease and left ventricular ejection fraction 35% or less to coronary artery bypass grafting with medical therapy or medical therapy alone with a median follow-up over 9.8 years. For the purpose of this study, optimal medical therapy was collected at baseline and 4 months, and defined as the combination of 4 drugs: angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, statin, and 1 antiplatelet drug. RESULTS: At baseline and 4 months, 58.7% and 73.3% of patients were receiving optimal medical therapy, respectively. These patients had no differences in important parameters such as left ventricular ejection fraction and left ventricular volumes. In a multivariable Cox model, optimal medical therapy at baseline was associated with a lower all-cause mortality (hazard ratio, 0.78; 95% confidence interval, 0.66-0.91; P = .001). When landmarked at 4 months, optimal medical therapy was also associated with a lower all-cause mortality (hazard ratio, 0.82; 95% confidence interval, 0.62-0.99; P = .04). There was no interaction between the benefit of optimal medical therapy and treatment allocation. CONCLUSIONS: Optimal medical therapy was associated with improved long-term survival and lower cardiovascular mortality in patients with ischemic cardiomyopathy and should be strongly recommended.

Recommended Citation

Farsky, P. S., White, J., Al-Khalidi, H. R., Sueta, C. A., Rouleau, J. L., Panza, J. A., Velazquez, E. J., & O'Connor, C. M. (2022). Optimal Medical Therapy With or Without Surgical Revascularization and Long-Term Outcomes in Ischemic Cardiomyopathy. The Journal of Thoracic and Cardiovascular Surgery, 164 (6), 1890-1899.e4. https://doi.org/10.1016/j.jtcvs.2020.12.094