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A decade after the Surgical Treatment for Ischemic Heart Failure (STICH) trial: Weaving firm clinical recommendations from lessons learned  Robert E.

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Presentation on theme: "A decade after the Surgical Treatment for Ischemic Heart Failure (STICH) trial: Weaving firm clinical recommendations from lessons learned  Robert E."— Presentation transcript:

1 A decade after the Surgical Treatment for Ischemic Heart Failure (STICH) trial: Weaving firm clinical recommendations from lessons learned  Robert E. Michler, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 157, Issue 3, Pages (March 2019) DOI: /j.jtcvs Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Kaplan-Meier estimates for mortality rates among patients randomized to optimal medical therapy or coronary artery bypass grafting (CABG) in the Surgical Treatment for Ischemic Heart Failure trial. A, Kaplan-Meier estimates of the rates of death from any cause. B, Death from cardiovascular causes. C, Death from any cause or hospitalization for cardiovascular causes. CI, Confidence interval. Reprinted with permission.5 The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Kaplan-Meier estimates of the rates of death from any cause in the Surgical Treatment for Ischemic Heart Failure trial. Coronary artery bypass grafting (CABG) compared with medical therapy alone (MED) led to a statistically significant 16% relative risk reduction in death rate and an 8% absolute risk reduction in all cause mortality. For every 100 patients treated, 8 deaths were prevented by CABG. CABG prevented 1 death for every 14 patients treated. CABG extended median survival by nearly 1.5 years. CI, Confidence interval; NNT, Number needed to treat. Reprinted with permission.5 The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Time-Varying Hazard Ratios for All-Cause Mortality in Patients Randomized to Receive coronary artery bypass grafting (CABG) or optimal medical therapy (MED) in the Surgical Treatment of Heart Failure trial. A time-dependent mortality hazard was observed between CABG and MED, demonstrating a higher 30-day risk associated with the CABG operative procedure and a midterm survival benefit associated with CABG. CI, Confidence interval. Reprinted with permission.12 The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Cardiovascular modes of death in the Surgical Treatment of Heart Failure trial. Patients undergoing coronary artery bypass grafting (CABG) surgery had a significantly reduced hazard risk of sudden death, pump failure, and deaths from myocardial infarction (MI) compared to patients treated with medical therapy (MED). These events are the consequence of critically diseased coronary arteries. CI, Confidence interval; CV, cardiovascular; CVA, cerebrovascular accident. Reprinted with permission.12 The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

6 CABG prevented 1 death for every 14 patients treated
CABG prevented 1 death for every 14 patients treated. CABG extended survival by 1.5 years. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions


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