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Surgical Treatment for Ischemic Heart Failure (STICH) trial: A review of outcomes

Ali Fatehi Hassanabad1, Kelsey T MacQueen1, Imtiaz Ali1

  • 1Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Faculty of Medicine, University of Calgary, Calgary, Canada.

Journal of Cardiac Surgery
|August 3, 2019
PubMed

Insights

Coronary artery disease (CAD) patients with severe left ventricle dysfunction benefit long-term from coronary artery bypass grafting (CABG) plus optimal medical therapy (OMT). Adding surgical ventricular reconstruction (SVR) to CABG showed no additional benefit over CABG alone.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Trials

Background:

  • Coronary artery disease (CAD) is a leading cause of death globally.
  • Severe left ventricle (LV) dysfunction (LVEF ≤ 35%) in CAD patients presents significant management challenges.
  • The Surgical Treatment for Ischemic Heart Failure (STICH) trial addressed critical questions in this patient population.

Purpose of the Study:

  • To review and synthesize data from the STICH trial and its sub-studies.
  • To provide a balanced assessment of the trial's findings and subsequent criticisms.
  • To inform evidence-based clinical decision-making for ischemic heart failure.

Main Methods:

  • The STICH trial investigated two primary hypotheses regarding surgical intervention for ischemic heart failure.
  • Hypothesis 1: Coronary artery bypass grafting (CABG) + optimal medical therapy (OMT) vs. OMT alone.
  • Hypothesis 2: CABG + surgical ventricular reconstruction (SVR) vs. CABG alone.

Main Results:

  • Ten-year follow-up demonstrated significant long-term survival benefits for CABG + OMT compared to OMT alone.
  • No significant difference in outcomes was observed between CABG + SVR and CABG alone.
  • Subanalyses have provided further insights and sparked ongoing debate.

Conclusions:

  • CABG in addition to OMT offers long-term benefits for patients with severe LV dysfunction and CAD.
  • SVR as an adjunct to CABG did not provide additional survival advantages in the STICH trial.
  • The STICH trial has significantly influenced, and at times challenged, established treatment paradigms for ischemic heart failure.

Keywords:
STICH Trialclinical reviewcoronary artery diseaseheart failure

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