title: The world post-STICH: is this a "Game Changer?" A non-invasive cardiologist's perspective-revascularization is the treatment of choice only in patients who fail medical therapy.
abstract: The optimal management for ischemic cardiomyopathy has been a clinical conundrum for years. Until the publication of the Surgical Treatment of Ischemic Cardiac Heart Failure (STICH) trial, recommendations have been primarily based upon expert opinion, retrospective literature, and clinical anecdotes. However, medical and device management have matured significantly in an era where surgical morbidity and mortality remain significant for coronary bypass grafting in the setting of severe left ventricular dysfunction. For the first time in years, there now exists a landmark prospective randomized clinical trial that addresses the role of coronary bypass surgery as an initial strategy for ischemic cardiomyopathy. Although many interpretations of STICH exist, the neutral results of STICH should reassure clinicians that a strategy of initiating and optimizing medical therapy and deferring surgical revascularization for ischemic cardiomyopathy in "STICH-like patients" is effective, safe, and tested.
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Chantal
authors.initials: C
authors.lastname: Elamm
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002309:Cardiology / Q000379:methods; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003657:Decision Making; D005069:Evaluation Studies as Topic; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018579:Patient Selection; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000628:therapy
chemical_list: D002317:Cardiovascular Agents