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Coronary artery disease: how should the STICH trial results affect clinical practice?

Michael J Mack1

  • 1Baylor Health Care System, 1100 Allied Drive, Plano, TX 75075, USA. michaema@baylorhealth.edu

Nature Reviews. Cardiology
|July 6, 2011
PubMed

Insights

Coronary artery bypass grafting (CABG) surgery may not improve cardiovascular outcomes for patients with coronary artery disease and left ventricular dysfunction on optimal medical therapy. However, severe coronary artery disease with viable myocardium warrants consideration for surgical revascularization.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Trials

Background:

  • Left ventricular dysfunction and coronary artery disease (CAD) are significant risk factors for cardiovascular events.
  • Optimal medical therapy (OMT) is the cornerstone of management for these patients.
  • The role of surgical revascularization in addition to OMT remains a critical question.

Purpose of the Study:

  • To evaluate the impact of coronary artery bypass grafting (CABG) surgery on cardiovascular outcomes in patients with CAD and left ventricular dysfunction receiving OMT.

Main Methods:

  • The study involved a large-scale, randomized controlled trial (STICH trial).
  • Patients with CAD and left ventricular dysfunction were randomized to either CABG plus OMT or OMT alone.
  • Primary endpoints included mortality and major cardiovascular events.

Main Results:

  • CABG surgery, when added to OMT, did not significantly improve long-term cardiovascular outcomes or reduce mortality compared to OMT alone.
  • A subgroup analysis suggested potential benefits in patients with severe CAD and evidence of viable myocardium.

Conclusions:

  • For patients with CAD and left ventricular dysfunction on OMT, CABG surgery does not consistently offer additional cardiovascular benefits.
  • Surgical revascularization remains a viable option for select patients with severe CAD and demonstrable viable myocardium.

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