Adding Bypass Surgery to Medical Therapy Benefits Heart Failure Patients

Coronary artery bypass surgery added to medical therapy for selected chronic heart failure patients offered benefits over medical therapy alone, NIH-funded research shows.¹ The combination of the two treatment approaches reduced the combined rate of deaths and heart-related hospital stays by 15%, although the total number of deaths between the two groups of patients was not significantly different.

According to researchers, the findings suggest that bypass surgery might be a viable option for more coronary heart disease patients than previously thought. Coronary artery bypass surgery has been routinely considered for patients with advanced heart failure only if they had symptoms, such as chest pain, that are directly attributable to reduced blood flow to the heart. However, many physicians did not think of coronary bypass surgery as a specific therapy for heart failure, a condition primarily caused by poor heart pump function.

Patients who survived the surgery experienced fewer heart-related hospital stays over the course of the follow-up period, which averaged 56 months.

The multi-center Surgical Treatment for Ischemic Heart Failure (STICH) trial examined whether adding coronary artery bypass surgery to medical therapy could reduce the number of deaths in patients with chronic heart failure. The research team enrolled 1,212 participants in 22 nations. Participants, with an average age of 60, were randomly assigned to one of two groups. The 602 patients in the medical therapy group received individualized treatment based on established guidelines, which would typically include drugs such as beta-blockers, ACE inhibitors, statins and aspirin. The second group of 610 participants received the same level of treatment as the medical therapy group, plus coronary artery bypass surgery.

The investigators found that adding bypass surgery to medical therapy resulted in a small, but not statistically significant, drop in the overall death rate, which was the main outcome sought in the study. Overall, 36% of patients in the surgery plus medical therapy group died during the follow-up period, compared with 41% of participants in the medical therapy group. The surgery plus medical therapy group had a statistically significant lower combined rate of death or heart-related hospital stays (58%) compared with a 68% rate for those in the medical therapy group.

Similarly, 28% of participants assigned to surgery plus medical therapy died from heart-related causes, compared with 33% of participants assigned to medical therapy alone.

1: Velazquez EJ, Lee KL, Deja MA, Jain A, Sopko G, Marchenko A, Ali IS, Pohost G, Gradinac S, Abraham WT, Yii M, Prabhakaran D, Szwed H, Ferrazzi P, Petrie MC,O'Connor CM, Panchavinnin P, She L, Bonow RO, Rankin GR, Jones RH, Rouleau JL;STICH Investigators. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med. 2011 Apr 28;364(17):1607-16. Epub 2011 Apr

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