Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction

Division of Cardiovascular Medicine, Duke University Medical Center, Durham, NC, USA.
New England Journal of Medicine (Impact Factor: 55.87). 04/2011; 364(17):1607-16. DOI: 10.1056/NEJMoa1100356
Source: PubMed

ABSTRACT The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established.
Between July 2002 and May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.
The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P=0.12). A total of 201 patients (33%) in the medical-therapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P=0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the follow-up period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG.
In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. (Funded by the National Heart, Lung, and Blood Institute and Abbott Laboratories; STICH number, NCT00023595.).

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Available from: Sinisa Gradinac, Sep 28, 2015
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    • "Non-blinded optimal medical therapy control An open-label comparison of OMT to the investigational device is appropriate in circumstances where no device or surgical comparator exists , and a sham is not feasible or ethical. Examples include the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) of conventional therapy versus amiodarone versus an implantable cardioverter defibrillator in patients with NYHA class II or III heart failure and a left ventricular ejection fraction (LVEF) of ≤35% [15] and the Surgical Treatment for Ischemic Heart Failure (STICH) trial of medical therapy versus coronary artery bypass graft surgery in patients with heart failure, LVEF ≤35%, and coronary artery disease [16]. This approach can be used to evaluate a new device versus OMT or the incremental benefit of the new device when added to conventional best therapy. "
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    • "Another weak point of the present study is the fact that only wall motion improvement was assessed as a short-term outcome. Viability studies usually require a long-term outcome as final end-point (27). Furthermore, how much viable myocardium was required for long-term improvement was another critical question which could not be answered appropriately (28). "
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