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"CABG in Patients with Heart Failure and Coronary Artery Disease". The New England Journal of Medicine. 2011. 364(17):1607-1616. PubMed • Full text • PDF

1 Clinical Question
2 Bottom Line
3 Major Points
4 Guidelines
5 Design
6 Population
6.1 Inclusion Criteria
6.2 Exclusion Criteria
6.3 Baseline Characteristics
7 Interventions
8 Outcomes
8.1 Primary Outcome
8.2 Secondary Outcomes
9 Funding
10 Further Reading

Clinical Question

Does coronary-artery bypass grafting (CABG), when added to medical therapy, improve survival in patients with coronary artery disease and heart failure?

Bottom Line

Among patients with coronary artery disease and left ventricular dysfunction, there was no significant difference between those who received medical therapy alone and those who received medical therapy plus CABG with respect to the primary end point of death from any cause. However, CABG did provide benefit with lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.

Major Points

Guidelines

Information on specific guideline updates influenced by this trial's findings is not provided.

Design

- Multicenter, nonblinded, randomized study
- N=1,212 patients with ejection fraction ≤35% and coronary artery disease amenable to CABG
- Medical therapy alone (n=602)
- Medical therapy plus CABG (n=610)
- Setting: 99 centers in 22 countries
- Enrollment: July 24, 2002, to May 5, 2007
- Median follow-up: 56 months
- Analysis: Intention-to-treat
- Primary outcome: Rate of death from any cause

Population

Inclusion Criteria
- Coronary artery disease amenable to CABG
- Ejection fraction of 35% or less

Exclusion Criteria
- Not specified in this summary, details can be found in provided Supplementary Appendix

Baseline Characteristics
- Well balanced between the two groups including demographic characteristics, clinical characteristics, and medication use

Interventions

- Medical therapy alone
- Medical therapy plus intended CABG within 14 days of randomization

Outcomes

Primary Outcome
- Death from any cause: 41% in medical therapy alone and 36% in CABG group (HR 0.86; 95% CI, 0.72 to 1.04; P=0.12)

Secondary Outcomes
- Death from cardiovascular causes: 33% in medical therapy alone and 28% in CABG group (HR 0.81; 95% CI, 0.66 to 1.00; P=0.05)
- Death from any cause or hospitalization for cardiovascular causes: 68% in medical therapy alone and 58% in CABG group (HR 0.74; 95% CI, 0.64 to 0.85; P<0.001)

Funding

The National Heart, Lung, and Blood Institute and Abbott Laboratories.