CABG and Medical Therapy Perform Equally Well in Patients With Heart Failure

New Orleans—A trial of 2 treatment strategies for heart failure, one much more expensive and invasive, found that both provide the same degree of protection against death within about 5 years after initiating treatment. Such a finding suggests that cardiologists will opt for the cheaper and less invasive therapy, but that may not be the case.

At issue is treatment of patients with coronary artery disease and left ventricular dysfunction. At the American College of Cardiology scientific session here in April, researchers compared the efficacy and safety of coronary artery bypass graft (CABG) surgery plus optimal medical therapy with medical therapy alone. The Surgical Treatment for Ischemic Heart Failure (STICH) trial included 1212 patients with left ventricular ejection fraction of 35% or less and coronary artery disease amenable to CABG, who were randomized to either treatment strategy. After a median follow-up of 56 months, 218 of 610 patients randomized to CABG plus medical therapy died compared with 244 of 602 patients randomized to medical therapy alone; CABG plus medical therapy reduced death rates by 14% compared with medical therapy alone, but the difference did not reach statistical significance (Velazquez EJ et al. N Engl J Med. 2011;364[17]:1607-1616).