Viability by MRI or PET would have changed the results of the STICH trial

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• The Surgical Treatment for Ischemic Heart Failure (STICH) trial assessed coronary artery bypass grafting (CABG) benefits.
• Viability testing using SPECT or dobutamine echocardiography did not identify survival advantages.
• Controversy exists regarding STICH conclusions and the role of advanced imaging.

Purpose of the Study:

• To re-evaluate the STICH trial findings in light of potential advancements in imaging techniques.
• To explore whether newer technologies like cardiac magnetic resonance (CMR) or positron emission tomography (PET) could alter conclusions.
• To understand the impact of improved medical therapy on the incremental benefit of revascularization.

Main Methods:

• The STICH trial utilized single-photon emission computed tomography (SPECT) and dobutamine echocardiography for viability assessment.
• The study compared outcomes of CABG versus optimal medical therapy in patients with ischemic cardiomyopathy.
• Analysis considers potential limitations in study design and performance.

Main Results:

• Viability assessment in STICH did not identify a subgroup of patients benefiting from CABG over medical therapy.
• Improvements in heart failure medical therapy have reduced the incremental benefit of revascularization.
• The study's primary findings suggest limited survival advantage for CABG in this population.

Conclusions:

• STICH trial results indicate that current viability testing methods are insufficient to guide CABG decisions for survival benefit.
• Advanced imaging techniques (CMR, PET) may be necessary to detect smaller survival benefits of CABG.
• Evolving medical therapies diminish the relative advantage of surgical intervention for ischemic cardiomyopathy.