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Randomized Controlled Trial
. 2019 Oct;7(10):878-887.
doi: 10.1016/j.jchf.2019.04.018. Epub 2019 Sep 11.

CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial

Jonathan G Howlett  1 , Amanda Stebbins  2 , Mark C Petrie  3 , Pardeep S Jhund  3 , Serenella Castelvecchio  4 , Alexander Cherniavsky  5 , Carla A Sueta  6 , Ambuj Roy  7 , Ileana L Piña  8 , Raphael Wurm  9 , Mark H Drazner  10 , Bert Andersson  11 , Carmen Batlle  12 , Michele Senni  13 , Lukasz Chrzanowski  14 , Bela Merkely  15 , Peter Carson  16 , Patrice M Desvigne-Nickens  17 , Kerry L Lee  2 , Eric J Velazquez  18 , Hussein R Al-Khalidi  2 ; STICH Trial Investigators
Affiliations
Randomized Controlled Trial

CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial

Jonathan G Howlett et al. JACC Heart Fail. 2019 Oct.

Abstract

Objectives: The authors investigated the impact of coronary artery bypass grafting (CABG) on first and recurrent hospitalization in this population.

Background: In the STICH (Surgical Treatment for Ischemic Heart Failure) trial, CABG reduced all-cause death and hospitalization in patients with and ischemic cardiomyopathy and left ventricular ejection fraction <35%.

Methods: A total of 1,212 patients were randomized (610 to CABG + optimal medical therapy [CABG] and 602 to optimal medical therapy alone [MED] alone) and followed for a median of 9.8 years. All-cause and cause-specific hospitalizations were analyzed as time-to-first-event and as recurrent event analysis.

Results: Of the 1,212 patients, 757 died (62.4%) and 732 (60.4%) were hospitalized at least once, for a total of 2,549 total all-cause hospitalizations. Most hospitalizations (66.2%) were for cardiovascular causes, of which approximately one-half (907 or 52.9%) were for heart failure. More than 70% of all hospitalizations (1,817 or 71.3%) were recurrent events. The CABG group experienced fewer all-cause hospitalizations in the time-to-first-event (349 CABG vs. 383 MED, adjusted hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.74 to 0.98; p = 0.03) and in recurrent event analyses (1,199 CABG vs. 1,350 MED, HR: 0.78, 95% CI: 0.65 to 0.94; p < 0.001). This was driven by fewer total cardiovascular (CV) hospitalizations (744 vs. 968; p < 0.001, adjusted HR: 0.66, 95% CI: 0.55 to 0.81; p = 0.001), the majority of which were due to HF (395 vs. 512; p < 0.001, adjusted HR: 0.68, 95% CI: 0.52-0.89; p = 0.005). We did not observe a difference in non-CV events.

Conclusions: CABG reduces all-cause, CV, and HF hospitalizations in time-to-first-event and recurrent event analyses. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595).

Keywords: coronary artery bypass grafting; heart failure; hospitalization; ischemic cardiomyopathy; morbidity.

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Figures

Figure 1:
Figure 1:
Frequency distribution of all-cause hospitalizations during follow- p.
Figure 2:
Figure 2:
All-cause hospitalization expressed as estimated rate per 100 patients as: Cumulative incidence (black lines) and Ghosh and Lin estimates accounting for the competing risk of all-cause death (red lines). CABG = coronary artery bypass surgery plus optimal medical therapy; MED = optimal medical therapy alone.
Figure 3:
Figure 3:
Mean cumulative incidence of all-cause hospitalization during the entire 9.8 year follow up period. CABG = coronary artery bypass surgery plus optimal medical therapy; MED = optimal medical therapy alone.
Figure 4:
Figure 4:
Mean cumulative incidence of all-cause hospitalization during the first 90 days post randomization. CABG = coronary artery bypass surgery plus optimal medical therapy; MED = optimal medical therapy alone.
Central Illustration:
Central Illustration:
Top panel: Patient disposition over the follow-up period of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. LVEF= left ventricular ejection fraction. Bottom panel: Mean cumulative incidence of all-cause hospitalization during the entire 9.8 year follow up period. CABG = coronary artery bypass surgery plus optimal medical therapy; MED = optimal medical therapy alone.
See this image and copyright information in PMC

Comment in

References

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