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CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial.

Publication ,  Journal Article
Howlett, JG; Stebbins, A; Petrie, MC; Jhund, PS; Castelvecchio, S; Cherniavsky, A; Sueta, CA; Roy, A; Piña, IL; Wurm, R; Drazner, MH; Senni, M ...
Published in: JACC Heart Fail
October 2019

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).

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

October 2019

Volume

7

Issue

10

Start / End Page

878 / 887

Location

United States

Related Subject Headings

  • Stroke Volume
  • Recurrence
  • Myocardial Ischemia
  • Mortality
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
 

Citation

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Howlett, J. G., Stebbins, A., Petrie, M. C., Jhund, P. S., Castelvecchio, S., Cherniavsky, A., … STICH Trial Investigators, . (2019). CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial. JACC Heart Fail, 7(10), 878–887. https://doi.org/10.1016/j.jchf.2019.04.018
Howlett, Jonathan G., Amanda Stebbins, Mark C. Petrie, Pardeep S. Jhund, Serenella Castelvecchio, Alexander Cherniavsky, Carla A. Sueta, et al. “CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial.JACC Heart Fail 7, no. 10 (October 2019): 878–87. https://doi.org/10.1016/j.jchf.2019.04.018.
Howlett JG, Stebbins A, Petrie MC, Jhund PS, Castelvecchio S, Cherniavsky A, et al. CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial. JACC Heart Fail. 2019 Oct;7(10):878–87.
Howlett, Jonathan G., et al. “CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial.JACC Heart Fail, vol. 7, no. 10, Oct. 2019, pp. 878–87. Pubmed, doi:10.1016/j.jchf.2019.04.018.
Howlett JG, Stebbins A, Petrie MC, Jhund PS, Castelvecchio S, Cherniavsky A, Sueta CA, Roy A, Piña IL, Wurm R, Drazner MH, Andersson B, Batlle C, Senni M, Chrzanowski L, Merkely B, Carson P, Desvigne-Nickens PM, Lee KL, Velazquez EJ, Al-Khalidi HR, STICH Trial Investigators. CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial. JACC Heart Fail. 2019 Oct;7(10):878–887.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

October 2019

Volume

7

Issue

10

Start / End Page

878 / 887

Location

United States

Related Subject Headings

  • Stroke Volume
  • Recurrence
  • Myocardial Ischemia
  • Mortality
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Female