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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Quality-of-life outcomes with coronary artery bypass graft surgery in ischemic left ventricular dysfunction: a
Insights
Coronary artery bypass grafting (CABG) significantly improved quality of life for patients with ischemic heart failure compared to medical therapy alone over 36 months. This surgical intervention offers a better quality of life for high-risk cardiac patients.
Area of Science:
- Cardiovascular Surgery
- Heart Failure Management
- Quality of Life Research
Background:
- The STICH trial investigated coronary artery bypass grafting (CABG) versus guideline-based medical therapy for ischemic left ventricular dysfunction.
- Ischemic left ventricular dysfunction affects numerous patients, necessitating evaluation of treatment impacts on daily living.
- Understanding treatment-related quality of life (QOL) is crucial for high-risk cardiac patients.
Purpose of the Study:
- To evaluate the quality of life (QOL) outcomes in patients undergoing CABG plus medical therapy versus medical therapy alone.
- To determine the long-term impact of surgical intervention on patient-reported QOL in ischemic heart failure.
Main Methods:
- A randomized trial involving 1212 patients with coronary artery disease and left ventricular ejection fraction ≤ 0.35.
- Patients were randomized to receive either medical therapy alone or medical therapy plus CABG.
- Quality of life was assessed using the Kansas City Cardiomyopathy Questionnaire at baseline and at 4, 12, 24, and 36 months post-randomization.
Main Results:
- The CABG group demonstrated consistently higher Kansas City Cardiomyopathy Questionnaire scores, indicating improved QOL, at all follow-up points (4, 12, 24, and 36 months).
- Statistically significant differences favoring CABG were observed at 4, 12, and 24 months, with a trend at 36 months.
- Sensitivity analyses confirmed these findings, accounting for mortality's impact on QOL assessments.
Conclusions:
- In symptomatic high-risk patients with ischemic left ventricular dysfunction, CABG in addition to medical therapy leads to clinically meaningful improvements in quality of life.
- The benefits of CABG on QOL are sustained over a 36-month period compared to medical therapy alone.
- These findings support CABG as a valuable treatment option for improving functional status and well-being in select heart failure patients.
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.
Design:
Randomized trial. (ClinicalTrials.gov: NCT00023595).
Setting:
99 clinical sites in 22 countries.
Patients:
1212 patients with a left ventricular ejection fraction of 0.35 or less and coronary artery disease.
Intervention:
Random assignment to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients).
Measurements:
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.
Limitation:
Therapy was not masked.
Conclusion:
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.
Primary Funding Source:
National Heart, Lung, and Blood Institute.
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