STICH examines the role of CABG in heart failure

While the efficacy of CABG in improving both morbidity and mortality in patients with severe coronary artery disease and angina was established in the 1970's, the majority of patients who took part in these initial ground-breaking studies had normal or near normal ventricular function. The role of CABG in treating patients with poor systolic LV function is less well established, especially in light of modern alternatives such as medical and device management.

The STICH trial was designed to assess these questions, and while the surgical ventricular reconstruction arm has already reported no benefit, the study also examined the role of CABG versus medical therapy alone. This multi-centre prospective randomised trial recruited 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG, without significant symptoms of angina (CCS class 0-II), with the majority having NYHA class II-III symptoms of heart failure. Of these, 601 underwent assessment of myocardial viability. Patients were assigned in a 1:1 fashion to either medical therapy or CABG and followed up for an average of 5 years. The primary outcome was death from any cause. Major secondary outcomes included death from cardiovascular causes and death from any cause or hospitalisation for cardiovascular causes.

There was no difference in the primary outcome of …