Abstract 16636: Left Ventricular Function and Remodeling Early After Coronary Artery Bypass Grafting Compared With Medical Therapy: Results From the Surgical Treatment for Ischemic Heart Failure (STICH)Trial
Background: Among patients with ischemic heart failure with reduced ejection fraction (EF), the impact of medical therapy (MED) versus coronary artery bypass grafting (CABG) on left ventricular (LV) structure and function has not been well established.
Method: The STICH trial randomized 1212 ischemic heart failure patients (EF ≤ 35%) to CABG or MED from 2002 through 2007. Echocardiogram, cardiac MRI, or radionuclide scan at baseline and 4 months were interpreted by blinded core labs. Among patients with paired imaging at baseline and 4 months, the change in EF, LV end systolic volume index (ESVI), and end diastolic volume index (EDVI) were evaluated by treatment as randomized. The association between changes at 4 months in EF, LVESVI and/or LVEDVI with subsequent all-cause mortality (50 months median follow-up) was tested in landmark analyses with the Cox model.
Results: Paired images were available on 523 patients (266 MED and 257 CABG) surviving to 4 months. EF improved slightly and to a similar extent in both the CABG and MED cohorts (Figure). LVESVI decreased in the CABG cohort (-3.9%), while it increased in the MED group (0.7%) (p<0.05). Similar findings were seen in LVEDVI (-2.4% in CABG vs 1.9% in MED, p=0.02). Among patients surviving to 4 months, the long-term benefit of CABG compared to MED was not dependent on changes in EF, LVESVI and LVEDVI (all interaction p-values >0.05). For estimating prognosis, the actual 4-month values of EF, LVESVI, and LVEDVI rather than the changes from baseline were of greatest prognostic importance (p<0.001). Analyses of the data according to treatment received and baseline viability status showed similar results.
Conclusion: Among STICH patients surviving to 4 months, EF increased to a similar extent after CABG or MED, while CABG led to modest improvement in LV remodeling. Changes in short-term LV function and remodeling do not fully explain the improved longer-term survival with CABG versus MED in patients with LV dysfunction.
- Coronary heart disease
- Heart failure
- Coronary artery bypass grafting (CABG)
- Myocardial revascularization
- Ventricular remodeling
Author Disclosures: E.J. Velazquez: None. S.D. Pokorney: Research Grant; Modest; AstraZeneca, Boston Scientific, Gilead. Consultant/Advisory Board; Modest; Janssen Pharmaceuticals. H. Szwed: None. R.E. Michler: None. C.A. Milano: None. P.S. Farsky: None. L. She: None. R.O. Bonow: None. G.M. Pohost: Research Grant; Modest; Gilead. J.L. Rouleau: None. L. Chrzanowski: None. T. Kukulski: None. K.L. Lee: None. D.N. Kosevic: None. L.N. Maia: None. J.A. Panza: None. G. Sopko: None. H.D. White: Consultant/Advisory Board; Modest; Astra Zeneca; Merck Sharpe & Dohme; Roche; Regado Biosciences. Research Grant; Significant; Sanofi Aventis; Eli Lilly; Medicines Company; NIH; Roche; Merck Sharpe & Dohme; Astra Zeneca; GSK; Daiichi Sankyo Pharma Development. J.K. Oh: None.
- © 2014 by American Heart Association, Inc.