Surgical Treatment for Ischemic Heart Failure (STICH) trial: A review of outcomes.

Abstract

Coronary artery disease (CAD) is a significant source of morbidity and mortality in developed countries. The landmark Surgical Treatment for Ischemic Heart Failure (STICH) trial has provided greatly needed evidence in the management of patients with severe left ventricle (LV) dysfunction (LVEF ≤ 35%) and CAD amenable to revascularization. The trial investigated two primary hypotheses: (i) that coronary artery bypass grafting (CABG) with optimal medical therapy (OMT) was superior to OMT alone, and (ii) that CABG with surgical ventricular reconstruction (SVR) would be superior to CABG alone. The results of the 10-year follow-up demonstrated significant long-term benefits with the addition of CABG to OMT. However, the second hypothesis yielded controversial results as the study found no difference between CABG with SVR and SVR alone. The STICH trial, and the numerous subanalyses that followed have reinforced and challenged a number of widely held beliefs regarding the management of patients with severe LV dysfunction and ischemic heart failure. The purpose of this comprehensive review is to outline the published data from the STICH trial and its substudies while providing a balanced assessment of the evidence-based conclusions and criticisms that have followed.