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STICH: CABG plus medical therapy yields marginal benefit in patients with HF, CAD
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American College of Cardiology 60th Annual Scientific Sessions
NEW ORLEANS – The addition of CABG to a regimen of optimal medical therapy in patients with HF and coronary artery disease was not associated with a significant benefit, but surgery was linked with lower risk for death from heart disease, results from the STICH trial suggested.
Researchers for the randomized Surgical Treatment of Ischemic Heart Failure trial enrolled 1,212 patients from 99 centers in 22 countries and randomly assigned them to either optimal medical therapy (n=602) or medical therapy plus CABG (n=610). Average follow-up was 56 months. The trial represented the largest randomized, controlled study comparing CABG plus optimal medical therapy to medical therapy alone in this patient population conducted to date.
According to the study data, the death rate in the CABG group was 36% vs. 41% with medical therapy alone, but the finding did not reach statistical significance (P=.12). However, CABG was linked with lower rates of CV death (28% vs. 33% with medical therapy alone; P=0.05) and lower rates of the combined endpoint of death from any cause plus hospitalization for heart disease (58% vs. 68% with medical therapy alone; P<.001). The researchers noted that 55 patients assigned to the surgery group did not undergo surgery, and 100 patients assigned to medical therapy alone ended up undergoing CABG. When looking specifically at the patients who had received their assigned treatments, however, CABG reduced any-cause death by 25% (P=0.005).
While the survival benefit of CABG was apparent after 2 years, the researchers cautioned that there was a higher up-front risk with CABG than with medical therapy alone.
“CAD should continue to be assessed among all patients presenting with HF, and in HF patients with CAD on medical therapy, CABG should now be considered to reduce CV mortality and morbidity,” Eric J. Velazquez, MD, associate professor of medicine and director of the cardiac diagnostic unit and echocardiography laboratories at Duke University Medical Center in Durham, N.C., said in a presentation. “The durability of CABG benefits will be tested in the STICH Extension Study, which is ongoing.” – by Eric Raible
Disclosure: Dr. Velazquez reports no relevant financial disclosures.
For more information:
- Velazquez E. LBCT II, Session 3013. Presented at: ACC 2011; April 3-5; New Orleans.
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