TY - JOUR
T1 - CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy
T2 - 10-Year Follow-Up of the STICH Trial
AU - STICH Trial Investigators
AU - Howlett, Jonathan G.
AU - Stebbins, Amanda
AU - Petrie, Mark C.
AU - Jhund, Pardeep S.
AU - Castelvecchio, Serenella
AU - Cherniavsky, Alexander
AU - Sueta, Carla A.
AU - Roy, Ambuj
AU - Piña, Ileana L.
AU - Wurm, Raphael
AU - Drazner, Mark H.
AU - Andersson, Bert
AU - Batlle, Carmen
AU - Senni, Michele
AU - Chrzanowski, Lukasz
AU - Merkely, Bela
AU - Carson, Peter
AU - Desvigne-Nickens, Patrice M.
AU - Lee, Kerry L.
AU - Velazquez, Eric J.
AU - Al-Khalidi, Hussein R.
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/10
Y1 - 2019/10
N2 - 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.
AB - 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.
KW - coronary artery bypass grafting
KW - heart failure
KW - hospitalization
KW - ischemic cardiomyopathy
KW - morbidity
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U2 - 10.1016/j.jchf.2019.04.018
DO - 10.1016/j.jchf.2019.04.018
M3 - Article
C2 - 31521682
AN - SCOPUS:85072293513
SN - 2213-1779
VL - 7
SP - 878
EP - 887
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 10
ER -