Author + information
- Received February 5, 2013
- Revision received April 17, 2013
- Accepted April 19, 2013
- Published online October 1, 2013.
- Peter Carson, MD∗∗ (, )
- John Wertheimer, MD†,
- Alan Miller, MD‡,
- Christopher M. O'Connor, MD§,
- Ileana L. Pina, MD‖,
- Craig Selzman, MD¶,
- Carla Sueta, MD#,
- Lilin She, PhD§,
- Deborah Greene, RN§,
- Kerry L. Lee, PhD§,
- Robert H. Jones, MD§,
- Eric J. Velazquez, MD§,
- STICH Investigators
- ∗Washington DC VA Medical Center, Washington DC
- †Pennsylvania Heart and Vascular Group, Philadelphia, Pennsylvania
- ‡University of Florida–Shands Jacksonville, Jacksonville, Florida
- §Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina
- ‖Montefiore Medical Center, Bronx, New York
- ¶University of Utah School of Medicine, Salt Lake City, Utah
- #University of North Carolina, Chapel Hill, North Carolina
- ↵∗Reprint requests and correspondence:
Dr. Peter Carson, Washington VA Medical Center, 50 Irving Street NW, Washington DC 20422.
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.
This work supported by grants (U01HL69015 and U01HL69013) from the National, Heart, Lung, and Blood Institute. Dr. Miller is a consultant for St. Jude Medical, Biotronik, Biocontrol, and Pfizer. Dr. Velazquez has received research grants from Abbott Vascular and Ikaria Pharmaceuticals; is on the advisory committee of Novartis; and is on the Speakers' Bureau of Gilead. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Michael R. Bristow, MD, PhD, acted as Guest Editor for this paper.
- Received February 5, 2013.
- Revision received April 17, 2013.
- Accepted April 19, 2013.
- American College of Cardiology Foundation