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STICH: CABG plus ventricular reconstruction did not improve overall survival
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American College of Cardiology 59th Annual Scientific Session
ATLANTA – Surgical ventricular reconstruction in addition to CABG led to a greater decrease in the size of the left ventricle when compared with CABG alone; however, the combination did not improve overall survival, according to an analysis of the STICH trial.
Researchers conducted the analysis to address concerns raised after STICH data presented at the American College of Cardiology 58th Annual Scientific Sessions indicated that surgical ventricular reconstruction (SVR) reduced end-systolic volume index by 19% compared with 6% with CABG alone. Similar improvements in cardiac symptoms and exercise tolerance with both procedures were also reported. Critics argued that study participants did not have sufficiently enlarged hearts and that SVR did not produce a significant reduction in ventricular volume.
For this analysis, researchers included data for 595 patients with adequate results for LV end-systolic volume index at baseline and four months post-surgery. Patients were divided into three groups based on end-systolic volume index baseline index:
- Group one: <60 mL/m²
- Group two: between 60 mL/m² and 90 mL/m²
- Group three: >90 mL/m²
At four months, patients assigned to group one who had CABG alone had no change in end-systolic volume index vs. patients assigned to CABG plus SVR who had a mean end-systolic volume index reduction of 4 mL/m² (P=0.049). Those assigned to group two who received CABG alone showed reductions in end-systolic volume index of 3 mL/m² (P=0.22); patients who received CABG plus SVR had a reduction of 17 mL/m² (P<.0001). Median reduction in end-systolic volume index was 18 mL/m² in those assigned to group three with CABG alone and 33 mL/m² in those treated with CABG plus SVR (P<.0001).
No significant differences were found for survival among those assigned to CABG alone or CABG plus SVR. However, increased survival for patients with a baseline end-systolic volume index of <90 mL/m² assigned to CABG plus SVR was reported.
“Large reductions in end-systolic volume index in a large ventricle does not appear to support the addition of SVR to CABG surgery,” Robert Michler, MD,surgeon-in-chief at Montefiore Medical Center at Albert College of Medicine, said during a presentation today. “A broad range of baseline end-systolic volume index is represented among this population, and postoperative end-systolic volume index decrease is significantly larger for those who received CABG plus SVR.” – by Jennifer Southall
For more information:
- Michler R. LBCT IV. Presented at: American College of Cardiology 59th Annual Scientific Sessions; March 13-16, 2010; Atlanta.
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