STICH
Trial question
What is the role of coronary artery bypass surgery in patients with LV dysfunction?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
12.0% female
88.0% male
N = 1212
1212 patients (148 female, 1064 male).
Inclusion criteria: patients with LV dysfunction (LVEF ≤ 35%) and coronary artery disease amenable to CABG.
Key exclusion criteria: plan for percutaneous intervention for CAD, cardiogenic shock within 72 hours of randomization, recent acute MI as a cause of LV dysfunction, noncardiac illness with a life expectancy of < 3 years, or history of > 1 coronary bypass operation.
Interventions
N=610 CABG (CABG plus medical therapy).
N=602 medical therapy (medical therapy alone).
Primary outcome
All-cause death
36%
41%
41.0 %
30.8 %
20.5 %
10.3 %
0.0 %
Coronary artery bypass
graft
Medical
therapy
No significant
difference ↔
No significant difference in all-cause death (36% vs. 41%; HR 0.86, 95% CI 0.72 to 1.04).
Secondary outcomes
Borderline significant decrease in adjudicated death due to cardiovascular cause (28% vs. 33%; HR 0.81, 95% CI 0.66 to 1).
Significant decrease in death from any cause or hospitalization for cardiovascular causes (58% vs. 68%; HR 0.74, 95% CI 0.64 to 0.85).
Conclusion
In patients with LV dysfunction (LVEF ≤ 35%) and coronary artery disease amenable to CABG, CABG was not superior to medical therapy with respect to a all-cause death.
Reference
Velazquez EJ, Lee KL, Deja MA et al. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med. 2011 Apr 28;364(17):1607-16.
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