Coronary-artery bypass surgery in patients with left ventricular dysfunction.

Abstract

BACKGROUND:

The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established.

METHODS:

Between July 2002 and 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 medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.

RESULTS:

The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P=0.12). A total of 201 patients (33%) in the medical-therapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P=0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the follow-up period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG.

CONCLUSIONS:

In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. (Funded by the National Heart, Lung, and Blood Institute and Abbott Laboratories; STICH ClinicalTrials.gov number, NCT00023595.).

• Authors: Eric J Velazquez, Kerry L Lee, Marek A Deja, Anil Jain, George Sopko, Andrey Marchenko, Imtiaz S Ali, Gerald Pohost, Sinisa Gradinac, William T Abraham, Michael Yii, Dorairaj Prabhakaran, Hanna Szwed, Paolo Ferrazzi, Mark C Petrie, Christopher M O'Connor, Pradit Panchavinnin, Lilin She, Robert O Bonow, Gena Roush Rankin, Robert H Jones, Jean-Lucien Rouleau, STICH Investigators
• Journal: The New England journal of medicine (N Engl J Med) Vol. 364 Issue 17 Pg. 1607-16 (Apr 28 2011) ISSN: 1533-4406 [Electronic] United States
• PMID: 21463150 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Cardiovascular Diseases (mortality)
• Combined Modality Therapy
• Coronary Artery Bypass
• Coronary Artery Disease (complications, drug therapy, surgery)
• Female
• Heart Failure (drug therapy, etiology, surgery)
• Hospitalization
• Humans
• Intention to Treat Analysis
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Proportional Hazards Models
• Ventricular Dysfunction, Left (drug therapy, etiology, surgery)