title: Quality-of-life outcomes with coronary artery bypass graft surgery in ischemic left ventricular dysfunction: a randomized trial.
abstract: BACKGROUND
  The STICH (Surgical Treatment for Ischemic Heart Failure) trial compared a strategy of routine coronary artery bypass grafting (CABG) with guideline-based medical therapy for patients with ischemic left ventricular dysfunction.
  
  
  OBJECTIVE
  To describe treatment-related quality-of-life (QOL) outcomes, a major prespecified secondary end point in the STICH trial.
  
  
  METHODS
  Randomized trial. (ClinicalTrials.gov: NCT00023595).
  
  
  METHODS
  99 clinical sites in 22 countries.
  
  
  METHODS
  1212 patients with a left ventricular ejection fraction of 0.35 or less and coronary artery disease.
  
  
  METHODS
  Random assignment to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients).
  
  
  METHODS
  A battery of QOL instruments at baseline (98.9% complete) and 4, 12, 24, and 36 months after randomization (collection rates were 80% to 89% of those eligible). The principal prespecified QOL measure was the Kansas City Cardiomyopathy Questionnaire, which assesses the effect of heart failure on patients' symptoms, physical function, social limitations, and QOL.
  
  
  RESULTS
  The Kansas City Cardiomyopathy Questionnaire overall summary score was consistently higher (more favorable) in the CABG group than in the medical therapy group by 4.4 points (95% CI, 1.8 to 7.0 points) at 4 months, 5.8 points (CI, 3.1 to 8.6 points) at 12 months, 4.1 points (CI, 1.2 to 7.1 points) at 24 months, and 3.2 points (CI, 0.2 to 6.3 points) at 36 months. Sensitivity analyses to account for the effect of mortality on follow-up QOL measurement were consistent with the primary findings.
  
  
  CONCLUSIONS
  Therapy was not masked.
  
  
  CONCLUSIONS
  In this cohort of symptomatic high-risk patients with ischemic left ventricular dysfunction and multivessel coronary artery disease, CABG plus medical therapy produced clinically important improvements in quality of life compared with medical therapy alone over 36 months.
  
  
  BACKGROUND
  National Heart, Lung, and Blood Institute.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.forename: J David
authors.initials: JD
authors.lastname: Knight
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Wasilewski
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Howlett
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Rajda
authors.forename: Rakesh
authors.initials: R
authors.lastname: Yadav
authors.forename: Baron L
authors.initials: BL
authors.lastname: Hamman
authors.forename: Marcin
authors.initials: M
authors.lastname: Malinowski
authors.forename: Ajay
authors.initials: A
authors.lastname: Naik
authors.forename: Gena
authors.initials: G
authors.lastname: Rankin
authors.forename: Tina M
authors.initials: TM
authors.lastname: Harding
authors.forename: Laura A
authors.initials: LA
authors.lastname: Drew
authors.forename: Patrice
authors.initials: P
authors.lastname: Desvigne-Nickens
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000601:surgery / Q000628:therapy; D001026:Coronary Artery Bypass; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000601:surgery / Q000628:therapy