It remains uncertain if surgical revascularization improves patient outcomes in the setting of coronary artery disease with reduced systolic function. This is particularly true in light of the STICH trial, a contemporary randomized control trial of coronary artery bypass graft surgery (CABG) with optimal medical therapy compared to optimal medical therapy alone in patients with ischemic left ventricular dysfunction. The primary results of the STICH trial demonstrated no overall mortality benefit to CABG with medical therapy compared to medical therapy alone. In this study, the trial authors report quality of life outcomes from the STICH trial. The trial randomized 1212 patients with an ejection fraction ≤35% with coronary anatomy suitable for surgical revascularization to either CABG with medical therapy or medical therapy alone. Quality of life assessments were performed at 4, 12, 24, and 36 months using validated patient-reported outcome measures, including the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Seattle Angina Questionnaire (SAQ), Center for Epidemiologic Studies Depression Scale, Cardiac Self-Efficacy Questionnaire, and EuroQol-5D. Patients receiving CABG with medical therapy had better quality of life scores in follow-up. Given the challenges of interpreting the clinical importance of these quality of life scores, the authors also reported the proportion of patients who achieved clinically meaningful improvements in KCCQ scores. This analysis demonstrated a number-needed-to-treat with CABG of between 9 and 14 patients to achieve one additional patient with a clinically meaningful improvement in KCCQ score.
Although the CABG for ischemic cardiomyopathy did not reduce all-cause mortality in the STICH trial, health-related quality of life measures consistently favored CABG with medical therapy over medical therapy alone through 36 months of follow-up.
Summarized by Javier A. Valle and Steven M. Bradley.
- Mark, D.B., et al., Quality-of-Life Outcomes With Coronary Artery Bypass Graft Surgery in Ischemic Left Ventricular Dysfunction: A Randomized Trial. Ann Intern Med, 2014. 161(6): p. 392-9.