Clinical characteristics of patients undergoing surgical ventricular reconstruction by choice and by randomization.
OBJECTIVE
The aim of this study was to confirm the generalizability of the conclusions of the STICH (Surgical Treatment for Ischemic Heart Failure) trial.


BACKGROUND
Surgical ventricular reconstruction (SVR) added to coronary artery bypass grafting (CABG) did not decrease death or cardiac hospitalization in STICH patients randomized to CABG with (n = 501) or without (n = 499) SVR.


METHODS
Baseline clinical characteristics of 1,000 STICH SVR hypothesis patients and 1,036 STICH-eligible Society of Thoracic Surgeons (STS) National Cardiac Database patients undergoing CABG plus SVR were entered into a multivariate model equation to predict a mortality that placed these 2,036 patients in 1 of 32 risk at randomization (RAR) groups. The number of patients in each RAR group profiled the risk of STICH treatment arms and of STICH and STS STICH-eligible patients.


RESULTS
That 85% of the 1,000 STICH patients known to have no significant differences in baseline characteristics between the 2 treatment arms shared the same RAR group suggests that the RAR methodology has sufficient accuracy to compare RAR profiles of STICH and STS patients. RAR group was shared by 1,522 of 2,036 STICH and STS STICH-eligible patients (75%) who underwent CABG plus SVR. Differences in baseline characteristics responsible for more low-risk STICH patients and more high-risk STS patients were modest. Cox proportional hazard ratios of 1,000 STICH patients in 3 RAR groups suggested by STICH and STS RAR differences showed no differential treatment effect on survival across the low-, intermediate-, and high-risk groups.


CONCLUSIONS
The STICH conclusion of no benefit from adding SVR to CABG applies to a broad spectrum of CABG-eligible patients with ischemic cardiomyopathy. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease; NCT00023595).
Zembala
Marian
M
Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Diseases/Medical University of Silesia, Zabrze-Katowice, Poland.
Michler
Robert E
RE
Rynkiewicz
Andrzej
A
Huynh
Thao
T
She
Lilin
L
Lubiszewska
Barbara
B
Hill
James A
JA
Jandova
Ruzena
R
Dagenais
Francois
F
Peterson
Eric D
ED
Jones
Robert H
RH
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology