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Sudden Death, Pump Failure Cut With CABG

Fri, 09/13/2013 - 11:45am
Todd Neale

For patients with ischemic cardiomyopathy and a reduced ejection fraction, the addition of coronary artery bypass grafting (CABG) to medical therapy reduced certain types of cardiovascular death, an analysis of the STICH trial showed.

Adding bypass surgery reduced rates of the two most common types of death in patients with chronic heart failure -- sudden death (12.1% versus 16.4%; HR 0.73, 95% CI 0.54-0.99) and fatal pump failure (5.4% versus 8.1%; HR 0.64, 95% CI 0.41-1.00), according to Peter Carson, MD, of the Washington D.C. VA Medical Center, and colleagues.

The benefits appeared after 2 years for both outcomes, the researchers reported online in JACC: Heart Failure.

There was also a reduction in deaths from MI (0.2% versus 2.2%; HR 0.07, 95% CI 0.01-0.57), although the advantages for CABG plus medical therapy were at least partly canceled out by a tripling of deaths related to complications from cardiovascular procedures (4.6% versus 1.5%; HR 3.11, 95% CI 1.47-6.60).

"These data represent the only prospective clinical trial experience evaluating the effect of CABG on mode of death in ischemic cardiomyopathy patients," Carson and colleagues wrote. "It is also one of the larger databases using committee-adjudicated results to examine mode of death in CABG patients."

The primary results of the STICH trial -- which compared CABG plus medical therapy with medical therapy alone -- showed no difference in the primary outcome of all-cause mortality (36% versus 41%, P=0.12). There was, however, a marginally significant reduction in the secondary endpoint of cardiovascular death (28% versus 33%, HR 0.81, P=0.05).

The researchers performed a more detailed analysis of the causes of the 462 deaths that occurred through a median follow-up of 56 months. Most of the deaths (76%) were from cardiovascular causes, 14.5% were from noncardiovascular causes, and the rest were from unknown causes.

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