Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 Sep 16;161(6):392-9.
doi: 10.7326/M13-1380.

Quality-of-life outcomes with coronary artery bypass graft surgery in ischemic left ventricular dysfunction: a randomized trial

Daniel B Mark, J David Knight, Eric J Velazquez, Jaroslaw Wasilewski, Jonathan G Howlett, Peter K Smith, John A Spertus, Miroslaw Rajda, Rakesh Yadav, Baron L Hamman, Marcin Malinowski, Ajay Naik, Gena Rankin, Tina M Harding, Laura A Drew, Patrice Desvigne-Nickens, Kevin J Anstrom
Randomized Controlled Trial

Quality-of-life outcomes with coronary artery bypass graft surgery in ischemic left ventricular dysfunction: a randomized trial

Daniel B Mark et al. Ann Intern Med. .

Abstract

Background: The STICH (Surgical Treatment for Ischemic Heart Failure) trial compared a strategy of routine coronary artery bypass grafting (CABG) with guideline-based medical therapy for patients with ischemic left ventricular dysfunction.

Objective: To describe treatment-related quality-of-life (QOL) outcomes, a major prespecified secondary end point in the STICH trial.

Design: Randomized trial. (ClinicalTrials.gov: NCT00023595).

Setting: 99 clinical sites in 22 countries.

Patients: 1212 patients with a left ventricular ejection fraction of 0.35 or less and coronary artery disease.

Intervention: Random assignment to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients).

Measurements: A battery of QOL instruments at baseline (98.9% complete) and 4, 12, 24, and 36 months after randomization (collection rates were 80% to 89% of those eligible). The principal prespecified QOL measure was the Kansas City Cardiomyopathy Questionnaire, which assesses the effect of heart failure on patients' symptoms, physical function, social limitations, and QOL.

Results: The Kansas City Cardiomyopathy Questionnaire overall summary score was consistently higher (more favorable) in the CABG group than in the medical therapy group by 4.4 points (95% CI, 1.8 to 7.0 points) at 4 months, 5.8 points (CI, 3.1 to 8.6 points) at 12 months, 4.1 points (CI, 1.2 to 7.1 points) at 24 months, and 3.2 points (CI, 0.2 to 6.3 points) at 36 months. Sensitivity analyses to account for the effect of mortality on follow-up QOL measurement were consistent with the primary findings.

Limitation: Therapy was not masked.

Conclusion: In this cohort of symptomatic high-risk patients with ischemic left ventricular dysfunction and multivessel coronary artery disease, CABG plus medical therapy produced clinically important improvements in quality of life compared with medical therapy alone over 36 months.

Primary funding source: National Heart, Lung, and Blood Institute.

PubMed Disclaimer

Figures

Figure 1
Figure 1
KCCQ overall summary scale. Higher scores indicate more favorable quality of life, fewer symptoms, and better functioning. Data are shown by intention to treat. Values below the x-axis are the numbers of patients with questionnaire data, patients who died, patients with missing questionnaire data, and patients with provided questionnaire data who had received CABG surgery at each follow-up assessment. CABG = coronary artery bypass grafting; KCCQ = Kansas City Cardiomyopathy Questionnaire.
Figure 2
Figure 2
SAQ angina frequency scale. Higher scores on the frequency scale reflect lower incidence of angina symptoms. Values below the x-axis are the numbers of patients with questionnaire data, patients who died, and patients with missing questionnaire data at each follow-up assessment. CABG = coronary artery bypass grafting; SAQ = Seattle Angina Questionnaire.
See this image and copyright information in PMC

Summary for patients in

References

    1. Fraker TD, Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2002 Chronic Stable Angina Writing Committee. 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol. 2007;50:2264–74. [PMID: 18061078] - PubMed
    1. Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on myocardial revascularization. Eur Heart J. 2010;31:2501–55. [PMID: 20802248] doi:10.1093/eurheartj/ehq277. - PubMed
    1. Eagle KA, Guyton RA, Davidoff R, Ewy GA, Fonger J, Gardner TJ, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). American College of Cardiology/American Heart Association. J Am Coll Cardiol. 1999;34:1262–347. [PMID: 10520819] - PubMed
    1. Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, et al. Results of coronary artery surgery in patients with poor left ventricular function (CASS) Circulation. 1983;68:785–95. [PMID: 6352078] - PubMed
    1. O'Connor CM, Velazquez EJ, Gardner LH, Smith PK, Newman MF, Landolfo KP, et al. Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank) Am J Cardiol. 2002;90:101–7. [PMID: 12106836] - PubMed

Publication types

MeSH terms

Associated data