Author + information
- Received February 12, 2019
- Revision received April 8, 2019
- Accepted April 14, 2019
- Published online September 30, 2019.
- Jonathan G. Howlett, MDa,∗ (, )@Jonathanhowlet6,
- Amanda Stebbins, MSb,
- Mark C. Petrie, MBChBc,
- Pardeep S. Jhund, MBChB, PhDc,
- Serenella Castelvecchio, MDd,
- Alexander Cherniavsky, MDe,
- Carla A. Sueta, MD, PhDf,
- Ambuj Roy, MDg,
- Ileana L. Piña, MD, MPHh,
- Raphael Wurm, MDi,
- Mark H. Drazner, MD, MScj,
- Bert Andersson, MDk,
- Carmen Batlle, MDl,
- Michele Senni, MDm,
- Lukasz Chrzanowski, MDn,
- Bela Merkely, MDo,
- Peter Carson, MDp,
- Patrice M. Desvigne-Nickens, MDq,
- Kerry L. Lee, PhDb,
- Eric J. Velazquez, MDr,
- Hussein R. Al-Khalidi, PhDb,
- on behalf of the STICH Trial Investigators
- aLibin Cardiovascular Institute and University of Calgary Medical Centre, Calgary, Canada
- bDuke Clinical Research Institute and Department of Biostatistics and Bioinformatics, Durham, North Carolina
- cBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- dIstituto Di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy
- eE. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
- fUniversity of North Carolina School of Medicine, Chapel Hill, North Carolina
- gAll India Institute of Medical Sciences, New Delhi, India
- hAlbert Einstein College of Medicine, Montefiore Medical Center, New York City, New York
- iMedical University of Vienna, Vienna, Austria
- jUniversity of Texas Southwestern Medical Center, Dallas, Texas
- kDepartment of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
- lCentro de Investigación Cardiovascular Uruguayo Casa De Galicia, Montevideo, Uruguay
- mPapa Giovanni XXIII Hospital, Bergamo, Italy
- nMedical University of Lodz, Lodz, Poland
- oSemmelweis University, Budapest, Budapest, Hungary
- pWashington VA Medical Center, Washington, DC
- qDivision of Cardiovascular Sciences, National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Maryland
- rSection of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- ↵∗Address for correspondence:
Dr. Jonathan G. Howlett, University of Calgary, Room C838, 1402-29th Street NW, Calgary, Alberta T2T 2X2, Canada.
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)
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. This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or National Institutes of Health. Dr. Anderson has received consultancy agreements with Novartis, OrionPharma, and Servier. Dr. Howlett has received consultancy agreements and research grants with Akcea, AstraZeneca, Boehringer Ingelheim, Novartis, Medtronic, and Servier. Dr. Velazquez has received research grants (significant) with Novartis, Amgen, National Heart, Lung, and Blood Institute, Pfizer, and Alnylam; and consultant/advisory board agreements (modest) with Novartis, Amgen, and Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 12, 2019.
- Revision received April 8, 2019.
- Accepted April 14, 2019.
- 2019 American College of Cardiology Foundation
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