Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy

Eric J. Velazquez, Kerry L. Lee, Robert H. Jones, Hussein R. Al-Khalidi, James A. Hill, Julio A. Panza, Robert E. Michler, Robert O. Bonow, Torsten Doenst, Mark C. Petrie, Jae K. Oh, Lilin She, Vanessa L Moore, Patrice Desvigne-Nickens, George Sopko, Jean L. Rouleau, STICHES Investigators, Serenella Castelvecchio, Lorenzo Menicanti

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear.

METHODS: From July 2002 to May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to undergo CABG plus medical therapy (CABG group, 610 patients) or medical therapy alone (medical-therapy group, 602 patients). The primary outcome was death from any cause. Major secondary outcomes included death from cardiovascular causes and death from any cause or hospitalization for cardiovascular causes. The median duration of follow-up, including the current extended-follow-up study, was 9.8 years.

RESULTS: A primary outcome event occurred in 359 patients (58.9%) in the CABG group and in 398 patients (66.1%) in the medical-therapy group (hazard ratio with CABG vs. medical therapy, 0.84; 95% confidence interval [CI], 0.73 to 0.97; P=0.02 by log-rank test). A total of 247 patients (40.5%) in the CABG group and 297 patients (49.3%) in the medical-therapy group died from cardiovascular causes (hazard ratio, 0.79; 95% CI, 0.66 to 0.93; P=0.006 by log-rank test). Death from any cause or hospitalization for cardiovascular causes occurred in 467 patients (76.6%) in the CABG group and in 524 patients (87.0%) in the medical-therapy group (hazard ratio, 0.72; 95% CI, 0.64 to 0.82; P<0.001 by log-rank test).

CONCLUSIONS: In a cohort of patients with ischemic cardiomyopathy, the rates of death from any cause, death from cardiovascular causes, and death from any cause or hospitalization for cardiovascular causes were significantly lower over 10 years among patients who underwent CABG in addition to receiving medical therapy than among those who received medical therapy alone. (Funded by the National Institutes of Health; STICH [and STICHES] ClinicalTrials.gov number, NCT00023595.).

Original languageEnglish
Pages (from-to)1511-20
Number of pages10
JournalNew England Journal of Medicine
Volume374
Issue number16
DOIs
Publication statusPublished - Apr 21 2016

Keywords

  • Aged
  • Cardiovascular Diseases
  • Cause of Death
  • Combined Modality Therapy
  • Coronary Artery Bypass
  • Female
  • Follow-Up Studies
  • Heart Failure
  • Hospitalization
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Myocardial Ischemia
  • Stroke Volume
  • Ventricular Dysfunction, Left
  • Journal Article
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

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  • Cite this

    Velazquez, E. J., Lee, K. L., Jones, R. H., Al-Khalidi, H. R., Hill, J. A., Panza, J. A., Michler, R. E., Bonow, R. O., Doenst, T., Petrie, M. C., Oh, J. K., She, L., Moore, V. L., Desvigne-Nickens, P., Sopko, G., Rouleau, J. L., STICHES Investigators, Castelvecchio, S., & Menicanti, L. (2016). Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy. New England Journal of Medicine, 374(16), 1511-20. https://doi.org/10.1056/NEJMoa1602001