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The STICH trial (Surgical Treatment for Ischemic Heart Failure): mode-of-death results.

Publication ,  Journal Article
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 ...
Published in: JACC Heart Fail
October 2013

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.

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

October 2013

Volume

1

Issue

5

Start / End Page

400 / 408

Location

United States

Related Subject Headings

  • Prospective Studies
  • Myocardial Ischemia
  • Middle Aged
  • Humans
  • Heart Failure
  • Coronary Artery Bypass
  • Combined Modality Therapy
  • Cause of Death
  • Aged
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Carson, P., Wertheimer, J., Miller, A., O’Connor, C. M., Pina, I. L., Selzman, C., … STICH Investigators, . (2013). The STICH trial (Surgical Treatment for Ischemic Heart Failure): mode-of-death results. JACC Heart Fail, 1(5), 400–408. https://doi.org/10.1016/j.jchf.2013.04.012
Carson, Peter, John Wertheimer, Alan Miller, Christopher M. O’Connor, Ileana L. Pina, Craig Selzman, Carla Sueta, et al. “The STICH trial (Surgical Treatment for Ischemic Heart Failure): mode-of-death results.JACC Heart Fail 1, no. 5 (October 2013): 400–408. https://doi.org/10.1016/j.jchf.2013.04.012.
Carson P, Wertheimer J, Miller A, O’Connor CM, Pina IL, Selzman C, et al. The STICH trial (Surgical Treatment for Ischemic Heart Failure): mode-of-death results. JACC Heart Fail. 2013 Oct;1(5):400–8.
Carson, Peter, et al. “The STICH trial (Surgical Treatment for Ischemic Heart Failure): mode-of-death results.JACC Heart Fail, vol. 1, no. 5, Oct. 2013, pp. 400–08. Pubmed, doi:10.1016/j.jchf.2013.04.012.
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, STICH Investigators. The STICH trial (Surgical Treatment for Ischemic Heart Failure): mode-of-death results. JACC Heart Fail. 2013 Oct;1(5):400–408.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

October 2013

Volume

1

Issue

5

Start / End Page

400 / 408

Location

United States

Related Subject Headings

  • Prospective Studies
  • Myocardial Ischemia
  • Middle Aged
  • Humans
  • Heart Failure
  • Coronary Artery Bypass
  • Combined Modality Therapy
  • Cause of Death
  • Aged
  • 3201 Cardiovascular medicine and haematology