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STICH (Surgical Treatment for Ischemic Heart Failure)

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- Population and treatment:
1212 patients with coronary artery disease amenable to coronary artery bypass graft (CABG) with LVEF <35%
Randomized to CABG or standard medical therapy alone

- Primary outcome:
All-cause death

STICH myocardial viability substudy:

- A substudy designed to determine whether substantial viable myocardium evident at baseline (visualized by SPECT imaging or dobutamine echo) affects all-cause mortality over five years or influences the relative effectiveness of the selected treatment strategy

See the article at http://www.theheart.org/article/1204899.do

Published in: Health & Medicine
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STICH (Surgical Treatment for Ischemic Heart Failure)

  1. 1. <ul><li>Population and treatment: </li></ul><ul><ul><li>1212 patients with coronary artery disease amenable to coronary artery bypass graft (CABG) with LVEF <35% </li></ul></ul><ul><li>Randomized to CABG or standard medical therapy alone </li></ul><ul><li>Primary outcome: </li></ul><ul><li>All-cause death </li></ul><ul><li>STICH myocardial viability substudy: </li></ul><ul><li>A substudy designed to determine whether substantial viable myocardium evident at baseline (visualized by SPECT imaging or dobutamine echo) affects all-cause mortality over five years or influences the relative effectiveness of the selected treatment strategy </li></ul>E Velazquez (Duke Clinical Research Institute, Durham, NC) RO Bonow (Northwestern University, Chicago, IL) American College of Cardiology 2011 Scientific Sessions STICH (Surgical Treatment for Ischemic Heart Failure)
  2. 2. <ul><li>Over a median follow-up of 56 months, 41% of the medical-therapy group and 36% of the CABG group died (p=0.12) </li></ul><ul><ul><li>Statistical significance attained following adjustment for baseline characteristics (p=0.039) </li></ul></ul><ul><li>Slight advantage shown for CABG in CV-specific causes of death: </li></ul><ul><ul><li>33% of the medical-therapy group and 28% of the CABG group died of an adjudicated CV cause (p=0.05) </li></ul></ul><ul><li>Slight advantage shown for CABG in composite secondary end point: </li></ul><ul><ul><li>68% of the patients on medical therapy died from any cause or were hospitalized for CV causes, compared with 58% of the CABG group (p<0.0001) </li></ul></ul>STICH: Results
  3. 3. STICH myocardial viability: Results <ul><li>36% less death in patients with substantial viability at baseline (p=0.003) </li></ul><ul><ul><li>This result became nonsignificant after adjustment for baseline prognostic features* (p=0.21) </li></ul></ul><ul><li>Viability was similarly associated with a significant 39% drop in CV death (p=0.003) </li></ul><ul><ul><li>This result also became nonsignificant after adjustment for baseline risk markers (p=0.34) </li></ul></ul><ul><li>A 41% fall in the composite of death or CV hospitalization (p<0.001) remained significant (p=0.003) after adjustment </li></ul><ul><li>There was no significant interaction between viability at baseline and whether the patient had been randomized to medical therapy only or meds plus CABG: </li></ul><ul><ul><li>For the end point of death from any cause (p=0.53), CV death (p=0.70), or death/CV hospitalization (p=0.39) </li></ul></ul><ul><ul><li>* LVEF, LV end-systolic and end-diastolic volume indexes, and a risk score derived from age, renal function, presence or absence of cerebrovascular disease, and other variables </li></ul></ul>
  4. 4. STICH: Commentary* *All comments from Docs say STICH &quot;hypothesis one&quot; supports CABG in HF patients despite missing primary end point (http://www.theheart.org/article/1205919.do) and STICH substudy: Viability testing didn't affect treatment outcomes (http://www.theheart.org/article/1204899.do) &quot;This is an incredible trial. A stunning achievement.&quot; - Dr Bernard Gersh &quot;With the results of the STICH trial, we should be comfortable with the notion that, in general, surgery is not superior to optimal medical therapy for ischemic left ventricular dysfunction.&quot; - Dr James Fang &quot;I think the results of our trial, with all its imperfections . . . suggest that the [idea] that every patient needs a viability test and that viability testing is going to be the key to the cath lab or the operating room now needs to be viewed with caution.&quot; - Dr Robert O Bonow

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