Coronary artery bypass graft (CABG) surgery may be beneficial for patients with coronary artery disease who were previously not considered candidates for the procedure, according to a study published in the New England Journal of Medicine.
Previously, CABG was considered too risky for patients with left ventricular dysfunction and heart failure.
“With limited data showing any benefit for patients with left ventricular dysfunction and heart failure, physicians and patients were less likely to engage in such an invasive, and thus risky, procedure as CABG for diagnosis and treatment,” said lead author Eric J. Velazquez, MD, FACP, FACC, FASE, FAHA, of Duke University Medical Center. “Patients with these conditions largely received medical therapy alone and had poor outcomes.”
The National Heart, Lung, and Blood Institute (NHLBI) funded the Surgical Treatment for Ischemic Heart Failure (STICH) trial and an additional 5-year extension study (STICHES). The study included 1,212 patients with an ejection fraction of ≤35% and coronary artery disease amenable to CABG. Patients were randomized to undergo CABG plus medical therapy (n=610) or medical therapy alone (n=602). The primary outcome was death from any cause, with a median follow-up of 9.8 years.
In the CABG group, a primary outcome event occurred in 359 (58.9%) patients, compared with 398 (66.1%) in the medical therapy group. A total of 247 (40.5%) patients in the CABG group died from cardiovascular causes, compared with 297 (49.3%) in the medical therapy group. The researchers also analyzed rates of death from any cause or hospitalization for cardiovascular causes, which occurred in 467 (76.6%) CABG patients and in 524 (87.0%) medical therapy patients.
“Conducting this trial was critically important to determine in a scientifically rigorous study that CABG improves survival for individuals with coronary artery disease and compromised left ventricular function,” said NHLBI Director Gary H. Gibbons, MD. “The current 10-year follow-up provides new important insights about patient subgroups that are more likely to benefit from CABG as compared to medical therapy alone. As such, we now have a solid evidence base to inform patient care and the future development of clinical practice recommendations.”
- Velazquez EJ, Lee KL, Jones RH, et al. Coronary-artery bypass surgery in patients with ischemic cardiomyopathy. New Engl J Med. Published online April 3, 2016. doi:10.1056/NEJMoa1602001.