CABG improves outcomes in patients with ischemic cardiomyopathy 10-year follow-up of the STICH trial

Howlett, J. G. et al. (2019) CABG improves outcomes in patients with ischemic cardiomyopathy 10-year follow-up of the STICH trial. JACC: Heart Failure, 7(10), pp. 878-887. (doi:10.1016/j.jchf.2019.04.018) (PMID:31521682)

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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)

Item Type:Articles
Additional Information:This work was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute grants U01 HL-69015, U01 HL-69013, and R01 HL-105853.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Jhund, Dr Pardeep and Petrie, Professor Mark
Authors: Howlett, J. G., Stebbins, A., Petrie, M. C., Jhund, P. S., Castelvecchio, S., Cherniavsky, A., Sueta, C. A., Roy, A., Piña, I. L., Wurm, R., Drazner, M. H., Andersson, B., Batlle, C., Senni, M., Chrzanowski, L., Merkely, B., Carson, P., Desvigne-Nickens, P. M., Lee, K. L., Velazquez, E. J., and Al-Khalidi, H. R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:JACC: Heart Failure
Publisher:Elsevier
ISSN:2213-1779
ISSN (Online):2213-1787
Published Online:11 September 2019

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