"CABG in Patients with Heart Failure and Coronary Artery Disease". The New England Journal of Medicine. 2011. 364(17):1607-1616. PubMed
Links to original sources: Wiki Journal Post Full Journal Article
Contents 1 Clinical Question 2 Bottom Line 3 Major Points 4 Guidelines 5 Design 6 Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7 Interventions 8 Outcomes 8.1 Primary Outcome 8.2 Secondary Outcomes 9 Funding 10 Further Reading
Does coronary-artery bypass grafting (CABG), when added to medical therapy, improve survival in patients with coronary artery disease and heart failure?
Among patients with coronary artery disease and left ventricular dysfunction, there was no significant difference between those who received medical therapy alone and those who received medical therapy plus CABG with respect to the primary end point of death from any cause. However, CABG did provide benefit with lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.
Randomized, comparative data had been lacking with respect to the benefits and risks of CABG in patients with coronary artery disease and non-acute heart failure. The Surgical Treatment for Ischemic Heart Failure (STICH) trial addressed this knowledge gap by comparing medical therapy alone with medical therapy plus CABG in patients with left ventricular systolic dysfunction and coronary artery disease amenable to CABG. Although no significant difference was observed in the primary outcome of all-cause mortality, patients assigned to CABG experienced lower rates of cardiovascular mortality and a reduction in death or hospitalization for cardiovascular causes.
Information on specific guideline updates influenced by this trial's findings is not provided.
- Multicenter, nonblinded, randomized study - N=1,212 patients with ejection fraction ≤35% and coronary artery disease amenable to CABG - Medical therapy alone (n=602) - Medical therapy plus CABG (n=610) - Setting: 99 centers in 22 countries - Enrollment: July 24, 2002, to May 5, 2007 - Median follow-up: 56 months - Analysis: Intention-to-treat - Primary outcome: Rate of death from any cause
Inclusion Criteria - Coronary artery disease amenable to CABG - Ejection fraction of 35% or less
Exclusion Criteria - Not specified in this summary, details can be found in provided Supplementary Appendix
Baseline Characteristics - Well balanced between the two groups including demographic characteristics, clinical characteristics, and medication use
- Medical therapy alone - Medical therapy plus intended CABG within 14 days of randomization
Primary Outcome - Death from any cause: 41% in medical therapy alone and 36% in CABG group (HR 0.86; 95% CI, 0.72 to 1.04; P=0.12)
- Death from cardiovascular causes: 33% in medical therapy alone and 28% in CABG group (HR 0.81; 95% CI, 0.66 to 1.00; P=0.05) - Death from any cause or hospitalization for cardiovascular causes: 68% in medical therapy alone and 58% in CABG group (HR 0.74; 95% CI, 0.64 to 0.85; P<0.001)
The National Heart, Lung, and Blood Institute and Abbott Laboratories.
- More information can be accessed on the New England Journal of Medicine website.