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

STICH Trial Investigators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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)

Original languageEnglish (US)
Pages (from-to)878-887
Number of pages10
JournalJACC: Heart Failure
Volume7
Issue number10
DOIs
StatePublished - Oct 2019

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Cardiomyopathies
Coronary Artery Bypass
Hospitalization
Heart Failure
Confidence Intervals
Therapeutics
Stroke Volume
Coronary Artery Disease
Cause of Death
Population

Keywords

  • coronary artery bypass grafting
  • heart failure
  • hospitalization
  • ischemic cardiomyopathy
  • morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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

In: JACC: Heart Failure, Vol. 7, No. 10, 10.2019, p. 878-887.

Research output: Contribution to journalArticle

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title = "CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial",
abstract = "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)",
keywords = "coronary artery bypass grafting, heart failure, hospitalization, ischemic cardiomyopathy, morbidity",
author = "{STICH Trial Investigators} and Howlett, {Jonathan G.} and Amanda Stebbins and Petrie, {Mark C.} and Jhund, {Pardeep S.} and Serenella Castelvecchio and Alexander Cherniavsky and Sueta, {Carla A.} and Ambuj Roy and Pi{\~n}a, {Ileana L.} and Raphael Wurm and Drazner, {Mark H.} and Bert Andersson and Carmen Batlle and Michele Senni and Lukasz Chrzanowski and Bela Merkely and Peter Carson and Desvigne-Nickens, {Patrice M.} and Lee, {Kerry L.} and Velazquez, {Eric J.} and Al-Khalidi, {Hussein R.}",
year = "2019",
month = "10",
doi = "10.1016/j.jchf.2019.04.018",
language = "English (US)",
volume = "7",
pages = "878--887",
journal = "JACC: Heart Failure",
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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.

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. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595)

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. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595)

KW - coronary artery bypass grafting

KW - heart failure

KW - hospitalization

KW - ischemic cardiomyopathy

KW - morbidity

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DO - 10.1016/j.jchf.2019.04.018

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JO - JACC: Heart Failure

JF - JACC: Heart Failure

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