Surgical Treatment for Ischemic Heart Failure (STICH) Trial: Mode of Death Results.
OBJECTIVE: To assess the effect of the addition of coronary artery bypass grafting (CABG) to medical therapy on mode of death in heart failure. BACKGROUND: While CABG therapy is widely used in ischemic cardiomyopathy patients, there is no prospective clinical trial data on mode of death. METHODS: The Surgical Treatment for Ischemic Heart Failure Trial (STICH) compared the strategy of CABG plus medical therapy to medical therapy alone in 1212 ischemic cardiomyopathy patients with reduced ejection fraction. A clinical events committee adjudicated deaths using pre-specified definitions for mode of death. RESULTS: In STICH, there were 462 deaths over a median follow-up of 56 months. The addition of CABG therapy tended to reduce cardiovascular deaths (HR 0.83; CI (0.68, 1.03),p=0.09) and significantly reduced the most common modes of death: sudden death (HR 0.73; CI (.54-.99) p=0.041) and fatal pump failure events (HR 0.64; CI (.41-1.00) 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 CI (1.47-6.60), but fatal myocardial infarction deaths were lower (HR 0.07 CI (0.01-0.57). Non- cardiovascular deaths were infrequent and did not differ between groups. CONCLUSION: In STICH, 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 while myocardial infarction deaths were decreased.
Carson, P; Wertheimer, J; Miller, A; O'Connor, CM; Pina, IL; Selzman, C; Sueta, C; She, L; Greene, D; Lee, KL; Jones, RH; Velazquez, EJ
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