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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EResults from the Surgical Treatment of Ischemic Heart Failure STICH trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00023595\u0026amp;atom=%2Fspmdc%2F11%2F3%2F20.atom\u0022\u003ENCT00023595\u003C\/a\u003E] showed no mortality benefit from coronary artery bypass grafting in addition to intensive guideline-based medical therapy compared with medical therapy alone.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EResults from the Surgical Treatment of Ischemic Heart Failure STICH trial (\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00023595\u0026amp;atom=%2Fspmdc%2F11%2F3%2F20.atom\u0022\u003ENCT00023595\u003C\/a\u003E) showed no mortality benefit from coronary artery bypass grafting (CABG) in addition to intensive guideline-based medical therapy compared with medical therapy alone. Results of the trial were presented by Eric J. Velazquez, MD, Duke University, Durham, North Carolina, USA.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe STICH trial comprised 1212 patients (median age 59 years) with coronary artery disease who were amenable to CABG and had an ejection fraction \u0026lt;35%. Subjects were randomly assigned to medical therapy alone (n=602) or medical therapy plus CABG (n=610). The primary study outcome was all-cause mortality. Major secondary outcomes included the rates of death from cardiovascular (CV) causes and death from any cause plus hospitalization for CV causes.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAfter a median follow-up of 56 months, there was no significant difference in the primary endpoint of death from any cause between those who were randomized to CABG compared with those who were randomized to medical therapy only (36% vs 41%; HR, 0.86; 95% CI, 0.72 to 1.04; p=0.12). CABG was associated with an early risk of death from any cause that persisted through 2 years. A significance level of p\u0026lt;0.04 was required to meet statistical significance for the primary outcome in order to compensate for interim treatment comparisons.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ESecondary outcomes showed fewer deaths from CV causes in the combination group versus the medical therapy-only group (28% vs 33%; HR, 0.81; 95% CI, 0.66 to 1.00; p=0.05). Death from any cause or hospitalization for CV causes was also lower in the combination group (58% vs 68%; HR, 0.74; 95% CI, 0.64 to 0.85; p\u0026lt;0.001; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12258\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12258\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12258\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003ESecondary Outcomes.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EAlmost all (91%) of the patients who were assigned to the combination group underwent CABG, and 17% of patients in the medical therapy-only group crossed over and also underwent CABG, primarily due to progressive symptoms (40%), followed by acute decompensation (27%), patient\u0027s or family\u0027s decision (28%), and physician\u0027s decision (5%).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ETwo exploratory analyses were performed\u2014one using the as-treated population (592 with medical therapy-only and 620 patients who underwent CABG during year 1 of follow-up) and the other using the per-protocol population, excluding patients who crossed over during the first year (537 medical therapy-only patients who did not cross over to CABG during the first year of follow-up and the 555 patients who were assigned to the combination group who actually underwent CABG). Results of these analyses showed a reduction in mortality in the patients who received CABG (as-treated HR, 0.70; 95% CI, 0.58 to 0.84; p\u0026lt;0.001; per-protocol HR, 0.76; 95% CI, 0.62 to 0.92; p=0.005). The as-treated comparison was analyzed using the Cox model, in which CABG was treated as a time-dependent covariate.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThe STICH trial was originally designed with a sample size of approximately 2000 patients with an anticipated follow-up of approximately 3 years. With this design, the study would have had 90% power to detect a 25% reduction in mortality with CABG as compared with medical therapy-alone, assuming a 3-year mortality of 25% in the medical therapy-only group. Because enrollment was slower than expected, the design was modified, with a reduced sample size of 1200 and an extended follow-up of 5 years.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EOverall, this important randomized trial showed no significant difference between CABG with medical therapy versus medical therapy alone. This neutral result may be in part due to inadequate power to detect differences within the range that was observed (16% reduction in hazard). While secondary and exploratory analyses suggest a benefit with CABG, these results must be interpreted with caution in this overall neutral trial.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section ref-list\u0022 id=\u0022ref-list-1\u0022\u003E\u003Ch2 class=\u0022\u0022\u003EFurther Reading\u003C\/h2\u003E\u003Col class=\u0022cit-list ref-use-labels\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label ref-label-empty\u0022\u003E\u003C\/span\u003E\n            \u003Cdiv class=\u0022cit ref-cit ref-journal no-rev-xref\u0022 id=\u0022cit-11.3.20.1\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EVelazquez\u003C\/span\u003E  \u003Cspan class=\u0022cit-name-given-names\u0022\u003EEJ\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E \n               \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003ENew Engl J Med\u003C\/abbr\u003E \n               \u003Cspan class=\u0022cit-pub-date\u0022\u003E2011\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/li\u003E\u003C\/ol\u003E\u003C\/div\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/3\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn3g1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzn3g1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}