February 19, 2018Circulation43 citationsOpen Access
View Full PaperSex Difference in Patients With Ischemic Heart Failure Undergoing Surgical Revascularization
Structured PICO
Does CABG added to medical therapy improve long-term outcomes differently in women versus men with ischemic left ventricular dysfunction?
P
Population
1212 patients (148 [12%] women and 1064 [88%] men) with coronary artery disease and left ventricular ejection fraction ≤35% enrolled in the STICH trial
I
Intervention
Coronary artery bypass grafting (CABG) plus medical therapy (MED)
C
Comparator
Medical therapy (MED) alone
O
Outcome
All-cause mortality, cardiovascular mortality, and the composite of all-cause mortality or cardiovascular hospitalization over 10 years of follow-uphard clinical
Despite having more baseline risk factors, women with ischemic heart failure have lower long-term mortality than men and derive a similar relative benefit from surgical revascularization, challenging the convention that female sex is a poor prognostic factor for CABG.
Abstract
Background: Female sex is conventionally considered a risk factor for coronary artery bypass grafting (CABG) and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We aimed to investigate the association of sex and the long-term benefit of CABG in patients with ischemic left ventricular dysfunction enrolled in the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure Study). Methods: The STICH trial randomized 1212 patients (148 12% women and 1064 88% men) with coronary artery disease and left ventricular ejection fraction ≤35% to CABG+medical therapy (MED) versus MED alone. Long-term (10-year) outcomes with each treatment were compared according to sex. Results: At baseline, women were older (63.4 versus 59.3 years; P =0.016) with higher body mass index (27.9 versus 26.7 kg/m 2 ; P =0.001). Women had more coronary artery disease risk factors (diabetes mellitus, 55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia, 70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower rates of prior CABG (0% versus 3.4%; all P 0.05). In addition, surgical deaths were not statistically different (1.5% versus 5.1%; P =0.187) between sexes among patients randomized to CABG per protocol as initial treatment. Conclusions: Sex is not associated with the effect of CABG+MED versus MED on all-cause mortality, cardiovascular mortality, the composite of death or cardiovascular hospitalization, or surgical deaths in patients with ischemic left ventricular dysfunction. Thus, sex should not influence treatment decisions about CABG in these patients. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00023595.