Document Detail


Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction.
MedLine Citation:
PMID:  23111018     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The present analysis of the Surgical Treatment for Ischemic Heart Failure randomized trial data examined the left ventricular volumes at baseline and 4 months after surgery to determine whether any magnitude of postoperative reduction in end-systolic volume affected survival after coronary artery bypass grafting alone compared with bypass grafting plus surgical ventricular reconstruction.
METHODS: Of the 1000 patients randomized, 555 underwent an operation and had a paired imaging assessment with the same modality at baseline and 4 months postoperatively. Of the remaining 455 patients, 424 either died before the 4-month study or did not have paired imaging tests and were excluded, and 21 were not considered because they had died before surgery or did not receive surgery.
RESULTS: Surgical ventricular reconstruction resulted in improved survival compared with coronary artery bypass grafting alone when the postoperative end-systolic volume index was 70 mL/m(2) or less. However, the opposite was true for patients achieving a postoperative volume index greater than 70 mL/m(2). A reduction in the end-systolic volume index of 30% or more compared with baseline was an infrequent event in both treatment groups and did not produce a statistically significant survival benefit with ventricular reconstruction.
CONCLUSIONS: In patients undergoing coronary artery bypass grafting plus surgical ventricular reconstruction, a survival benefit was realized compared with bypass alone, with the achievement of a postoperative end-systolic volume index of 70 mL/m(2) or less. Extensive ventricular remodeling at baseline might limit the ability of ventricular reconstruction to achieve a sufficient reduction in volume and clinical benefit.
Authors:
Robert E Michler; Jean L Rouleau; Hussein R Al-Khalidi; Robert O Bonow; Patricia A Pellikka; Gerald M Pohost; Thomas A Holly; Jae K Oh; Francois Dagenais; Carmelo Milano; Krzysztof Wrobel; Jan Pirk; Imtiaz S Ali; Robert H Jones; Eric J Velazquez; Kerry L Lee; Marisa Di Donato;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-10-27
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  146     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-10-16     Completed Date:  2014-01-07     Revised Date:  2014-11-04    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1139-1145.e6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 The American Association for Thoracic Surgery. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Bypass* / adverse effects,  mortality
Coronary Artery Disease / diagnosis,  mortality,  physiopathology,  surgery*
Female
Heart Ventricles / pathology,  physiopathology,  surgery*
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Reconstructive Surgical Procedures* / adverse effects,  mortality
Recovery of Function
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Ventricular Remodeling
Grant Support
ID/Acronym/Agency:
5U01-HL-69010/HL/NHLBI NIH HHS; 5U01-HL-69013/HL/NHLBI NIH HHS; 5U01-HL-69015/HL/NHLBI NIH HHS; U01 HL069010/HL/NHLBI NIH HHS; U01 HL069013/HL/NHLBI NIH HHS; U01 HL069015/HL/NHLBI NIH HHS; U01 HL088939/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 2013 Nov;146(5):1304-5   [PMID:  24128911 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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