CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial

Abstract

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. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595).

Keywords: coronary artery bypass grafting; heart failure; hospitalization; ischemic cardiomyopathy; morbidity.

Copyright © 2019 American College of Cardiology Foundation. All rights reserved.

Figures

Figure 1:

Frequency distribution of all-cause hospitalizations during follow- p.

Figure 2:

All-cause hospitalization expressed as estimated rate per 100 patients as: Cumulative incidence (black lines) and Ghosh and Lin estimates accounting for the competing risk of all-cause death (red lines). CABG = coronary artery bypass surgery plus optimal medical therapy; MED = optimal medical therapy alone.

Figure 3:

Mean cumulative incidence of all-cause hospitalization during the entire 9.8 year follow up period. CABG = coronary artery bypass surgery plus optimal medical therapy; MED = optimal medical therapy alone.

Figure 4:

Mean cumulative incidence of all-cause hospitalization during the first 90 days post randomization. CABG = coronary artery bypass surgery plus optimal medical therapy; MED = optimal medical therapy alone.

Central Illustration:

Top panel: Patient disposition over the follow-up period of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. LVEF= left ventricular ejection fraction. Bottom panel: Mean cumulative incidence of all-cause hospitalization during the entire 9.8 year follow up period. CABG = coronary artery bypass surgery plus optimal medical therapy; MED = optimal medical therapy alone.