Document Detail

Clinical characteristics of patients undergoing surgical ventricular reconstruction by choice and by randomization.
MedLine Citation:
PMID:  20670761     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to confirm the generalizability of the conclusions of the STICH (Surgical Treatment for Ischemic Heart Failure) trial.
BACKGROUND: Surgical ventricular reconstruction (SVR) added to coronary artery bypass grafting (CABG) did not decrease death or cardiac hospitalization in STICH patients randomized to CABG with (n = 501) or without (n = 499) SVR.
METHODS: Baseline clinical characteristics of 1,000 STICH SVR hypothesis patients and 1,036 STICH-eligible Society of Thoracic Surgeons (STS) National Cardiac Database patients undergoing CABG plus SVR were entered into a multivariate model equation to predict a mortality that placed these 2,036 patients in 1 of 32 risk at randomization (RAR) groups. The number of patients in each RAR group profiled the risk of STICH treatment arms and of STICH and STS STICH-eligible patients.
RESULTS: That 85% of the 1,000 STICH patients known to have no significant differences in baseline characteristics between the 2 treatment arms shared the same RAR group suggests that the RAR methodology has sufficient accuracy to compare RAR profiles of STICH and STS patients. RAR group was shared by 1,522 of 2,036 STICH and STS STICH-eligible patients (75%) who underwent CABG plus SVR. Differences in baseline characteristics responsible for more low-risk STICH patients and more high-risk STS patients were modest. Cox proportional hazard ratios of 1,000 STICH patients in 3 RAR groups suggested by STICH and STS RAR differences showed no differential treatment effect on survival across the low-, intermediate-, and high-risk groups.
CONCLUSIONS: The STICH conclusion of no benefit from adding SVR to CABG applies to a broad spectrum of CABG-eligible patients with ischemic cardiomyopathy. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease; NCT00023595).
Marian Zembala; Robert E Michler; Andrzej Rynkiewicz; Thao Huynh; Lilin She; Barbara Lubiszewska; James A Hill; Ruzena Jandova; Francois Dagenais; Eric D Peterson; Robert H Jones
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  56     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-09-28     Revised Date:  2013-08-20    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  499-507     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Diseases/Medical University of Silesia, Zabrze-Katowice, Poland.
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MeSH Terms
Cardiac Surgical Procedures / methods*
Coronary Artery Bypass / methods
Follow-Up Studies
Heart Failure / etiology,  mortality,  surgery*
Heart Ventricles / surgery*
Middle Aged
Myocardial Ischemia / complications,  physiopathology,  surgery*
Patient Selection*
Prospective Studies
Reconstructive Surgical Procedures / methods*
Risk Assessment / methods*
Stroke Volume
Survival Rate / trends
Treatment Outcome
Ventricular Function, Left / physiology
Grant Support
U01 HL069013/HL/NHLBI NIH HHS; U01 HL069015/HL/NHLBI NIH HHS; U01 HL069015-01/HL/NHLBI NIH HHS; U01 HL069015-02/HL/NHLBI NIH HHS; U01 HL069015-03/HL/NHLBI NIH HHS; U01 HL069015-04/HL/NHLBI NIH HHS; U01 HL069015-05/HL/NHLBI NIH HHS; U01 HL069015-06/HL/NHLBI NIH HHS; U01 HL069015-07/HL/NHLBI NIH HHS; U01 HL069015-07S1/HL/NHLBI NIH HHS; U01 HL069015-07S2/HL/NHLBI NIH HHS; U01-HL69015/HL/NHLBI NIH HHS
Comment In:
J Am Coll Cardiol. 2010 Aug 3;56(6):508-9   [PMID:  20670762 ]

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