Abstract
BACKGROUND: Whether the preoperative anemia affects the prognosis and the therapeutic choice between coronary artery bypass grafting (CABG) or medical therapy alone in patients with ischemic cardiomyopathy (ICM) remains unclear. We assess the influence of preoperative anemia on long-term outcomes in ICM patients treated with medical therapy alone with or without CABG. METHODS: Patients with preoperative hemoglobin were included from the Surgical Treatment of Ischemic Heart Failure (STICH) trial. The primary outcome was long-term all-cause mortality. RESULTS: A total of 1,209 patients were enrolled, with 320 (26.5%) patients with anemia, and 889 (73.5%) without anemia. The median follow-up time was 9.7 years. Compared with patients without anemia, patients with anemia had a higher risk of all-cause mortality [adjusted hazard ratio (aHR): 1.15; 95% confidence interval (CI): 0.98 to 1.36] and cardiovascular mortality (aHR: 1.26; 95% CI: 1.04 to 1.53). Among patients with anemia, CABG provided a significant survival benefit compared with medical therapy alone (all-cause mortality: aHR: 0.64; 95% CI: 0.48 to 0.85; cardiovascular mortality: aHR: 0.54; 95% CI: 0.39 to 0.76). Though with borderline statistical significance, CABG also provided additional survival benefit among patients without anemia (all-cause mortality: aHR: 0.87; 95% CI: 0.73 to 1.03; cardiovascular mortality: aHR: 0.83; 95% CI: 0.68 to 1.01). Sensitivity analyses based on as-treated principle showed the consistent results. CONCLUSIONS: Preoperative anemia is an independent risk factor for mortality in patients with ICM, whereas preoperative anemia does not affect the long-term survival benefits associated with CABG, which might help surgeons in making rational therapeutic decisions during clinical practice.