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Re-analysis of the Effect of Coronary Artery Bypass Surgery in Patients With Left Ventricular Dysfunction

      The role of coronary revascularization with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy remains poorly defined.
      • Patterson T
      • McConkey HZR
      • Ahmed-Jushuf F
      • Moschonas K
      • Nguyen H
      • Karamasis GV
      • et al.
      Long-term outcomes following heart team revascularization recommendations in complex coronary artery disease.
      The current American Heart Association/American College of Cardiology guidelines classify the use of CABG in patients with left ventricular ejection fraction < 35% as a IIb indication, and no recommendations are given for PCI in ischemic cardiomyopathy.
      • Yancy CW
      • Jessup M
      • Bozkurt B
      • Butler J
      • Casey DE
      • Drazner MH
      • et al.
      2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
      The Surgical Treatment for Ischemic Cardiomyopathy (STICH) trial,
      • Velazquez EJ
      • Lee KL
      • Deja MA
      • Jain A
      • Sopko G
      • Marchenko A
      • et al.
      Coronary-artery bypass surgery in patients with left ventricular dysfunction.
      conducted between July 2002 and May 2007, randomized 1212 patients with left ventricular ejection fraction < 35% and by-passable vessels to CABG plus guideline-directed medical therapy (GDMT) vs GDMT alone. At 6 years, there was no statistically significant difference in all-cause mortality between CABG and GDMT (41% vs 36%; hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.72–1.04; P = 0.12) based on intention-to-treat.
      • Velazquez EJ
      • Lee KL
      • Deja MA
      • Jain A
      • Sopko G
      • Marchenko A
      • et al.
      Coronary-artery bypass surgery in patients with left ventricular dysfunction.
      The lack of significance was thought to be due to the delayed benefit of revascularization, outweighing only the postoperative mortality rate with sufficient follow-up duration. This phenomenon was borne out in the long-term follow-up Surgical Treatment for Ischemic Heart Failure Extension Study (STICHES), which showed a statistically significant difference in survival in favor of the CABG group at 11 years (59% vs 66%; HR: 0.84; 95% CI: 0.73–0.97; P = 0.02).
      • Velazquez EJ
      • Lee KL
      • Jones RH
      • HR Al-Khalidi
      • Hill JA
      • Panza JA
      • et al.
      Coronary-artery bypass surgery in patients with ischemic cardiomyopathy.
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        Long-term outcomes following heart team revascularization recommendations in complex coronary artery disease.
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