ACC.16: CABG reduces long-term rates of death and hospitalizations in patients with ischemic cardiomyopathy

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CHICAGO – After nearly 10 years of follow-up, patients with ischemic cardiomyopathy who underwent CABG and received medical therapy had significantly lower rates of death from any cause, death from cardiovascular causes and death from any cause or hospitalization for cardiovascular causes compared with patients who only received medical therapy.

Lead researcher Eric J. Velazquez, MD, of the Duke University Medical Center, presented the results at the ACC scientific session on April 3. The findings were simultaneously published online in The New England Journal of Medicine. The National Institutes of Health funded the study.

“CABG was associated with more favorable results than medical therapy alone across all clinically relevant long-term outcomes we evaluated,” the researchers wrote.

In this trial, known as STICHES (Surgical Treatment for Ischemic Heart Failure Extension Study), the researchers randomized 1,212 patients with an ejection fraction of 35 percent or less and coronary artery disease amenable to CABG to undergo CABG plus medical therapy or medical therapy alone. The patients were randomized between July 24, 2002 and May 5, 2007 at 99 sites in 22 countries.

The groups were well balanced. The mean age was approximately 60 years old, while 88 percent of patients were male and 65 percent were white.

Of the patients in the CABG group, 91 percent underwent CABG before the study ended. The median time from randomization to CABG was 10 days. Of the patients who underwent CABG, 91 percent received at least one arterial conduit and 85.5 percent received at least one venous conduit.

After a median follow-up of 9.8 years, 58.9 percent of patients in the CABG group and 66.1 percent of patients in the medical therapy group had died. The median survival was 7.73 years in the CABG group and 6.29 years in the medical therapy group.

In addition, 40.5 percent of patients in the CABG group and 49.3 percent of patients in the medical therapy group died from cardiovascular causes, while death from any cause or hospitalization for cardiovascular causes occurred in 76.6 percent and 87.0 percent of patients, respectively.

“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,” Gary H. Gibbons, director of the National Heart, Lung, and Blood Institute, said in a news release. “As such, we now have a solid evidence base to inform patient care and the future development of clinical practice recommendations.”