title: The STICH trial (Surgical Treatment for Ischemic Heart Failure): mode-of-death results.
abstract: OBJECTIVE
  This study sought to assess the effect of the addition of coronary artery bypass grafting (CABG) to medical therapy on mode of death in heart failure.
  
  
  BACKGROUND
  Although CABG therapy is widely used in ischemic cardiomyopathy patients, there are no prospective clinical trial data on mode of death.
  
  
  METHODS
  The STICH (Surgical Treatment for Ischemic Heart Failure ) trial compared the strategy of CABG plus medical therapy to medical therapy alone in 1,212 ischemic cardiomyopathy patients with reduced ejection fraction. A clinical events committee adjudicated deaths using pre-specified definitions for mode of death.
  
  
  RESULTS
  In the STICH trial, there were 462 deaths over a median follow-up of 56 months. The addition of CABG therapy tended to reduce cardiovascular deaths (hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.68 to 1.03; p = 0.09) and significantly reduced the most common modes of death: sudden death (HR: 0.73; 95% CI: 0.54 to 0.99; p = 0.041) and fatal pump failure events (HR: 0.64; 95% CI: 0.41 to 1.00; p = 0.05). Time-dependent estimates indicate that the protective effect of CABG principally occurred after 24 months in both categories. Deaths post-cardiovascular procedures were increased in CABG patients (HR: 3.11; 95% CI: 1.47 to 6.60), but fatal myocardial infarction deaths were lower (HR: 0.07; 95% CI: 0.01 to 0.57). Noncardiovascular deaths were infrequent and did not differ between groups.
  
  
  CONCLUSIONS
  In the STICH trial, the addition of CABG to medical therapy reduced the most common modes of death: sudden death and fatal pump failure events. The beneficial effects were principally seen after 2 years. Post-procedure deaths were increased in patients randomized to CABG, whereas myocardial infarction deaths were decreased.
authors.affiliation: Washington DC VA Medical Center, Washington DC. Electronic address: peter.carson@va.gov.
authors.forename: Peter
authors.initials: P
authors.lastname: Carson
authors.affiliation: Pennsylvania Heart and Vascular Group, Philadelphia, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Wertheimer
authors.affiliation: University of Florida-Shands Jacksonville, Jacksonville, Florida.
authors.forename: Alan
authors.initials: A
authors.lastname: Miller
authors.affiliation: Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Montefiore Medical Center, Bronx, New York.
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Pina
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Craig
authors.initials: C
authors.lastname: Selzman
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Carla
authors.initials: C
authors.lastname: Sueta
authors.affiliation: Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Lilin
authors.initials: L
authors.lastname: She
authors.affiliation: Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Deborah
authors.initials: D
authors.lastname: Greene
authors.affiliation: Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.affiliation: Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Jones
authors.affiliation: Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
mesh_terms: D000368:Aged; D002423:Cause of Death; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D011446:Prospective Studies
keywords: heart failure; mode of death; surgical