Marcus Flather, MD; John Pepper, MD
In patients with coronary artery disease (CAD) and left ventricular (LV) systolic dysfunction, how effective is coronary artery bypass grafting (CABG) plus medical therapy compared with medical therapy alone for preventing death?
Randomized controlled trial (Surgical Treatment for Ischemic Heart Failure [STICH]). ClinicalTrials.gov NCT00023595.
Blinded (outcome adjudicators).*
Median 56 months.
99 centers in 22 countries.
1212 adults ≥ 18 years of age (median age 60 y, 88% men) who had CAD amenable to CABG and LV ejection fraction (LVEF) ≤ 35%. Exclusion criteria included cardiogenic shock, need for aortic valve repair or replacement, planned percutaneous intervention, recent myocardial infarction, > 1 prior CABG, ≥ 50% left main CAD, and angina markedly limiting ordinary activity (Canadian Cardiovascular Society angina class ≥ III).
CABG within 14 days of randomization plus medical therapy (n = 610) or medical therapy alone (n = 602). CABG was performed by surgeons with death rates ≤ 5% during CABG performed on ≥ 25 patients with LVEF ≤ 40%. A lead cardiologist at each center recommended the most appropriate medications and devices for treatment.
Death from any cause. Secondary outcomes included cardiovascular (CV) death and a composite of death from any cause or hospitalization for CV causes.
99.6% (intention-to-treat analysis).
Median baseline LVEF was 27% for the CABG plus medical therapy group and 28% for the medical therapy alone group. 91% of patients assigned to CABG plus medical therapy and 17% of those assigned to medical therapy alone had CABG before the end of the study. The main results are in the Table.
In patients with coronary artery disease and heart failure, coronary artery bypass grafting plus medical therapy did not reduce mortality compared with medical therapy alone.
Coronary artery bypass grafting (CABG) plus medical treatment (Med) vs Med alone in coronary artery disease with heart failure†
†CV = cardiovascular; other abbreviations defined in Glossary. RRR, NNT, and CI calculated from hazard ratios in article (adjusted for patient stratum) and control event rates.
‡P = 0.05
Flather M, Pepper J. CABG added no benefit to medical therapy for preventing death in coronary artery disease with heart failure. Ann Intern Med. ;155:JC2–9. doi: 10.7326/0003-4819-155-4-201108160-02009
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Published: Ann Intern Med. 2011;155(4):JC2-9.
Cardiology, Coronary Heart Disease.
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