Bypass Surgery Gets Nod in Large Comparative Study
Results of the National Institutes of Health-initiated study were presented today (4/4) at the American College of Cardiology’s scientific conference. The study is published online in the New England Journal of Medicine at http://www.nejm.org/doi/full/10.1056/NEJMoa1100356 .
Dr. William Abraham, director of the division of cardiovascular medicine at The Ohio State University Medical Center and one of the study’s authors, said the Surgical Treatment for Ischemic Heart Failure (STICH) trial supports many current practices in the treatment of patients with coronary heart disease and heart failure.
“The study shows that routine evaluation of coronary artery disease in patients with heart failure should prompt serious consideration of coronary artery bypass surgery in patients with significant disease,” said Abraham.
While patients assigned to coronary bypass surgery had lower rates of cardiovascular death and death or cardiovascular hospitalization than those assigned to medical therapy, there was statistically no difference in mortality from all causes between the two study groups. The average follow-up for patients was 56 months.
“The STICH trial does answer one of the unanswered questions in heart failure by describing the statistical risks and benefits of bypass surgery in such patients. It is a landmark study that will undoubtedly impact patient management and outcomes,” said Abraham.
The study results provide greater insight into the management of coronary artery disease using today’s high-tech therapies and replaces much older research data, some of it from the 1970s.
The randomized study enrolled patients from more than 99 centers in 22 counties. Ohio State University Medical Center led the nation in study enrollment and was one of the top five enrollment centers in the world. Patients were enrolled in the study between 2002 and 2007, with final medical follow-up occurring late last year on 1,212 patients.
Of the 1,212 patients, 602 patients were assigned to receive medical therapy and 610 were randomized to receive medical therapy plus coronary artery bypass surgery.
Of patients assigned to the medical therapy and surgical arms of the study, respectively, 201 (33 percent) died from cardiovascular causes compared to 168 (28 percent), a finding that was significant. Death from all causes occurred in 244 patients (41 percent) in the medical therapy arm and 218 (36 percent) in the bypass surgery arm, a difference not statistically significant.
Heart failure is one of the more serious cardiac conditions in which the heart can no longer pump enough blood to the rest of the body. Approximately 50 percent of people with heart failure die within the first five years after diagnosis.
The study by Abraham and colleagues is one of two landmark studies presented at the American College of Cardiology conference today. OSU Medical Center cardiologist Philip Binkley was a site principal investigator and author of a companion study from the STICH trial that examined myocardial viability and survival in ischemic left ventricular dysfunction. A copy of the study is available at: http://medicalcenter.osu.edu/viewer/Pages/index.aspx?newsid=6480
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