TY - JOUR
T1 - CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy
T2 - 10-Year Follow-Up of the STICH Trial
AU - STICH Trial Investigators
AU - Howlett, Jonathan G.
AU - Stebbins, Amanda
AU - Petrie, Mark C.
AU - Jhund, Pardeep S.
AU - Castelvecchio, Serenella
AU - Cherniavsky, Alexander
AU - Sueta, Carla A.
AU - Roy, Ambuj
AU - Piña, Ileana L.
AU - Wurm, Raphael
AU - Drazner, Mark H.
AU - Andersson, Bert
AU - Batlle, Carmen
AU - Senni, Michele
AU - Chrzanowski, Lukasz
AU - Merkely, Bela
AU - Carson, Peter
AU - Desvigne-Nickens, Patrice M.
AU - Lee, Kerry L.
AU - Velazquez, Eric J.
AU - Al-Khalidi, Hussein R.
N1 - Funding Information:
This work was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute grants U01 HL-69015, U01 HL-69013, and R01 HL-105853. This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or National Institutes of Health. Dr. Anderson has received consultancy agreements with Novartis, OrionPharma, and Servier. Dr. Howlett has received consultancy agreements and research grants with Akcea, AstraZeneca, Boehringer Ingelheim, Novartis, Medtronic, and Servier. Dr. Velazquez has received research grants (significant) with Novartis, Amgen, National Heart, Lung, and Blood Institute, Pfizer, and Alnylam; and consultant/advisory board agreements (modest) with Novartis, Amgen, and Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
This work was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute grants U01 HL-69015, U01 HL-69013, and R01 HL-105853. This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or National Institutes of Health. Dr. Anderson has received consultancy agreements with Novartis, OrionPharma, and Servier. Dr. Howlett has received consultancy agreements and research grants with Akcea, AstraZeneca, Boehringer Ingelheim, Novartis, Medtronic, and Servier. Dr. Velazquez has received research grants (significant) with Novartis, Amgen, National Heart, Lung, and Blood Institute, Pfizer, and Alnylam; and consultant/advisory board agreements (modest) with Novartis, Amgen, and Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/10
Y1 - 2019/10
N2 - Objectives: The authors investigated the impact of coronary artery bypass grafting (CABG) on first and recurrent hospitalization in this population. Background: In the STICH (Surgical Treatment for Ischemic Heart Failure) trial, CABG reduced all-cause death and hospitalization in patients with and ischemic cardiomyopathy and left ventricular ejection fraction <35%. Methods: A total of 1,212 patients were randomized (610 to CABG + optimal medical therapy [CABG] and 602 to optimal medical therapy alone [MED] alone) and followed for a median of 9.8 years. All-cause and cause-specific hospitalizations were analyzed as time-to-first-event and as recurrent event analysis. Results: Of the 1,212 patients, 757 died (62.4%) and 732 (60.4%) were hospitalized at least once, for a total of 2,549 total all-cause hospitalizations. Most hospitalizations (66.2%) were for cardiovascular causes, of which approximately one-half (907 or 52.9%) were for heart failure. More than 70% of all hospitalizations (1,817 or 71.3%) were recurrent events. The CABG group experienced fewer all-cause hospitalizations in the time-to-first-event (349 CABG vs. 383 MED, adjusted hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.74 to 0.98; p = 0.03) and in recurrent event analyses (1,199 CABG vs. 1,350 MED, HR: 0.78, 95% CI: 0.65 to 0.94; p < 0.001). This was driven by fewer total cardiovascular (CV) hospitalizations (744 vs. 968; p < 0.001, adjusted HR: 0.66, 95% CI: 0.55 to 0.81; p = 0.001), the majority of which were due to HF (395 vs. 512; p < 0.001, adjusted HR: 0.68, 95% CI: 0.52-0.89; p = 0.005). We did not observe a difference in non-CV events. Conclusions: CABG reduces all-cause, CV, and HF hospitalizations in time-to-first-event and recurrent event analyses.
AB - Objectives: The authors investigated the impact of coronary artery bypass grafting (CABG) on first and recurrent hospitalization in this population. Background: In the STICH (Surgical Treatment for Ischemic Heart Failure) trial, CABG reduced all-cause death and hospitalization in patients with and ischemic cardiomyopathy and left ventricular ejection fraction <35%. Methods: A total of 1,212 patients were randomized (610 to CABG + optimal medical therapy [CABG] and 602 to optimal medical therapy alone [MED] alone) and followed for a median of 9.8 years. All-cause and cause-specific hospitalizations were analyzed as time-to-first-event and as recurrent event analysis. Results: Of the 1,212 patients, 757 died (62.4%) and 732 (60.4%) were hospitalized at least once, for a total of 2,549 total all-cause hospitalizations. Most hospitalizations (66.2%) were for cardiovascular causes, of which approximately one-half (907 or 52.9%) were for heart failure. More than 70% of all hospitalizations (1,817 or 71.3%) were recurrent events. The CABG group experienced fewer all-cause hospitalizations in the time-to-first-event (349 CABG vs. 383 MED, adjusted hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.74 to 0.98; p = 0.03) and in recurrent event analyses (1,199 CABG vs. 1,350 MED, HR: 0.78, 95% CI: 0.65 to 0.94; p < 0.001). This was driven by fewer total cardiovascular (CV) hospitalizations (744 vs. 968; p < 0.001, adjusted HR: 0.66, 95% CI: 0.55 to 0.81; p = 0.001), the majority of which were due to HF (395 vs. 512; p < 0.001, adjusted HR: 0.68, 95% CI: 0.52-0.89; p = 0.005). We did not observe a difference in non-CV events. Conclusions: CABG reduces all-cause, CV, and HF hospitalizations in time-to-first-event and recurrent event analyses.
KW - coronary artery bypass grafting
KW - heart failure
KW - hospitalization
KW - ischemic cardiomyopathy
KW - morbidity
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U2 - 10.1016/j.jchf.2019.04.018
DO - 10.1016/j.jchf.2019.04.018
M3 - Article
C2 - 31521682
AN - SCOPUS:85072293513
SN - 2213-1779
VL - 7
SP - 878
EP - 887
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 10
ER -