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Randomized Controlled Trial
. 2013 Oct;1(5):400-8.
doi: 10.1016/j.jchf.2013.04.012. Epub 2013 Sep 11.

The STICH trial (Surgical Treatment for Ischemic Heart Failure): mode-of-death results

Peter Carson  1 , John Wertheimer  2 , Alan Miller  3 , Christopher M O'Connor  4 , Ileana L Pina  5 , Craig Selzman  6 , Carla Sueta  7 , Lilin She  4 , Deborah Greene  4 , Kerry L Lee  4 , Robert H Jones  4 , Eric J Velazquez  4 ; STICH Investigators
Affiliations
Randomized Controlled Trial

The STICH trial (Surgical Treatment for Ischemic Heart Failure): mode-of-death results

Peter Carson et al. JACC Heart Fail. 2013 Oct.

Abstract

Objectives: This study sought to assess the effect of the addition of coronary artery bypass grafting (CABG) to medical therapy on mode of death in heart failure.

Background: Although CABG therapy is widely used in ischemic cardiomyopathy patients, there are no prospective clinical trial data on mode of death.

Methods: The STICH (Surgical Treatment for Ischemic Heart Failure ) trial compared the strategy of CABG plus medical therapy to medical therapy alone in 1,212 ischemic cardiomyopathy patients with reduced ejection fraction. A clinical events committee adjudicated deaths using pre-specified definitions for mode of death.

Results: In the STICH trial, there were 462 deaths over a median follow-up of 56 months. The addition of CABG therapy tended to reduce cardiovascular deaths (hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.68 to 1.03; p = 0.09) and significantly reduced the most common modes of death: sudden death (HR: 0.73; 95% CI: 0.54 to 0.99; p = 0.041) and fatal pump failure events (HR: 0.64; 95% CI: 0.41 to 1.00; p = 0.05). Time-dependent estimates indicate that the protective effect of CABG principally occurred after 24 months in both categories. Deaths post-cardiovascular procedures were increased in CABG patients (HR: 3.11; 95% CI: 1.47 to 6.60), but fatal myocardial infarction deaths were lower (HR: 0.07; 95% CI: 0.01 to 0.57). Noncardiovascular deaths were infrequent and did not differ between groups.

Conclusions: In the STICH trial, the addition of CABG to medical therapy reduced the most common modes of death: sudden death and fatal pump failure events. The beneficial effects were principally seen after 2 years. Post-procedure deaths were increased in patients randomized to CABG, whereas myocardial infarction deaths were decreased.

Keywords: heart failure; mode of death; surgical.

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Figures

Figure 1
Figure 1
Cardiovascular modes of death: Hazard ratios and confidence intervals
Figure 2
Figure 2
Sudden death KM curves
Figure 3
Figure 3
Pump failure KM curves
Figure 4
Figure 4
Cardiovascular, Sudden Death, pump failure, and Non-cardiovascular deaths by treatment group for LVEF and NYHA subgroups
See this image and copyright information in PMC

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