CABG Bests Medical Therapy in Ischemic Heart Failure

April 5, 2011

Compared with medical therapy alone, coronary artery bypass grafting (CABG) significantly reduced cardiovascular deaths and the composite end point of all-cause deaths and cardiovascular-related hospitalizations, reported investigators from the Surgical Treatment of Ischemic Heart Failure (STICH) trial. However, the effect of the two management strategies on overall survival in patients with ischemic heart failure was similar.

Compared with medical therapy alone, coronary artery bypass grafting (CABG) significantly reduced cardiovascular deaths and the composite end point of all-cause deaths and cardiovascular-related hospitalizations, reported investigators from the Surgical Treatment of Ischemic Heart Failure (STICH) trial.1 However, the effect of the two management strategies on overall survival in patients with ischemic heart failure was similar.

The STICH study is the largest randomized, controlled trial ever to compare CABG plus the best possible medical therapy to aggressive medical therapy alone in patients with coronary artery disease and heart failure. The results were presented at the American College of Cardiology's Annual Scientific Session in New Orleans and were published online in the New England Journal of Medicine.

More than 1200 patients with ischemic heart failure were recruited for the study. Researchers randomly assigned 602 patients to ideal medical therapy alone and 610 to CABG plus ideal medical therapy. After an average of nearly 5 years of follow-up, they found that bypass surgery reduced the risk of death from any cause by 14% when compared to medical therapy. However, the finding was not statistically significant.

Bypass surgery also reduced the risk of cardiovascular death by 19% and the combined risk of death from any cause plus hospitalization for heart disease by 26%. Both findings were statistically significant (P = .05 and P < .001, respectively).

A caveat: the researchers noted that because of the risks of surgery, the survival benefit associated with CABG did not become apparent until 2 years later.

"Although the totality of information supports CABG, there is an early hazard,” said study author Eric J. Velazquez, MD, associate professor of medicine at Duke University Medical Center in Durham, NC. “The fairest approach is to evaluate each patient’s prognosis. If they have a low likelihood of living 2 years or don’t want to take the risk of having surgery, medical therapy may be the better option."

REFERENCE:
1.
Velaquez EJ, et al. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med. 2011; DOI: 10.1056/NEJMoa1100356.

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