Six-minute walk distance after coronary artery bypass grafting compared with medical therapy in ischaemic cardiomyopathy.
Abstract
In patients with ischaemic left ventricular dysfunction, coronary artery bypass surgery
(CABG) may decrease mortality, but it is not known whether CABG improves functional
capacity.To determine whether CABG compared with medical therapy alone (MED) increases
6 min walk distance in patients with ischaemic left ventricular dysfunction and coronary
artery disease amenable to revascularisation.The Surgical Treatment in Ischemic Heart
disease trial randomised 1212 patients with ischaemic left ventricular dysfunction
to CABG or MED. A 6 min walk distance test was performed both at baseline and at least
one follow-up assessment at 4, 12, 24 and/or 36 months in 409 patients randomised
to CABG and 466 to MED. Change in 6 min walk distance between baseline and follow-up
were compared by treatment allocation.6 min walk distance at baseline for CABG was
mean 340±117 m and for MED 339±118 m. Change in walk distance from baseline was similar
for CABG and MED groups at 4 months (mean +38 vs +28 m), 12 months (+47 vs +36 m),
24 months (+31 vs +34 m) and 36 months (-7 vs +7 m), P>0.10 for all. Change in walk
distance between CABG and MED groups over all assessments was also similar after adjusting
for covariates and imputation for missing values (+8 m, 95% CI -7 to 23 m, P=0.29).
Results were consistent for subgroups defined by angina, New York Heart Association
class ≥3, left ventricular ejection fraction, baseline walk distance and geographic
region.In patients with ischaemic left ventricular dysfunction CABG compared with
MED alone is known to reduce mortality but is unlikely to result in a clinically significant
improvement in functional capacity.NCT00023595.
Type
Journal articleSubject
clinical trialcoronary artery bypass grafting
exercise capacity
ischemic cardiomyopathy
six-minute walk distance
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https://hdl.handle.net/10161/16485Published Version (Please cite this version)
10.1136/openhrt-2017-000752Publication Info
Stewart, Ralph AH; Szalewska, Dominika; Stebbins, Amanda; Al-Khalidi, Hussein R; Cleland,
John GH; Rynkiewicz, Andrzej; ... Petrie, Mark C (2018). Six-minute walk distance after coronary artery bypass grafting compared with medical
therapy in ischaemic cardiomyopathy. Open heart, 5(1). 10.1136/openhrt-2017-000752. Retrieved from https://hdl.handle.net/10161/16485.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Hussein Rashid Al-Khalidi
Professor of Biostatistics & Bioinformatics
My research interest includes design and analysis of cardiovascular clinical trials,
medical devices, survival analysis, group-sequential analysis, time-to-recurrent or
multiple events, continuous-time Markov models, stochastic process, linear model,
dose-response modeling, design of experiments and adaptive designs.
Daniel Benjamin Mark
Professor of Medicine
Dr. Mark is a clinical cardiologist with the rank of Professor of Medicine (with tenure)
as well as Vice Chief for Academic Affairs in the Division of Cardiology, Department
of Medicine at Duke University Medical Center. He is also the Director of Outcomes
Research at the Duke Clinical Research Institute. He has been on the full-time faculty
at Duke since 1985. Prior to that he completed his cardiology fellowship at Duke,
his residency and internship at the University of Virginia Hospital, and r
Eric J. Velazquez
Adjunct Professor in the Department of Medicine
LeadershipEric J. Velazquez, MD, is a Professor of Medicine with tenure at Duke University.
As section chief for Cardiovascular Imaging in the Division of Cardiology and director
of the Cardiac Diagnostic Unit and Echocardiography Laboratories for Duke University
Health System, he coordinates a high-volume enterprise and an outstanding group of
clinician-investigators and clinical staff who make important contributions across
patient care, research and educational
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