Until now, most heart patients with some kinds of coronary artery disease were denied coronary artery bypass grafts (CABG) because it was thought few would benefit from the expensive and dangerous operation.
However, a long-term study by the National Institutes of Health (NIH) funded by the National Heart, Lung, and Blood Institute (NHLBI) has shown that a far greater number of patients would benefit from the CABG surgery than previously considered.
CABG improves blood flow to the heart muscle by using implants to bypass the arteries already clogged with cholesterol plaque.
Left Ventricular Dysfunction Patients
In particular, those with left ventricular dysfunction (the left side doesn’t pump properly) and heart failure were thought too risky to perform CABG and since the ’70s they were essentially excluded from anything but pain medication and experienced poor outcomes (they soon died).
It is estimated that by 2030 there will be nearly eight million individuals in the United States alone with left ventricular dysfunction because of advances in the management of cardiovascular disease and its risk factors, which may lead to more people surviving mild cases and eventually becoming advanced chronic cases.
Eric J. Velazquez, MD, FACP, FACC, FASE, FAHA, of Duke University Medical Center headed a randomized controlled clinical trial extending over five years (the Surgical Treatment for Ischemic Heart Failure (STICH) study) and a further five years (STICHES), to determine whether whether CABG combined with drug therapy actually had a long-term benefit versus medical therapy alone for those patients with coronary artery disease and in particular left ventricular dysfunction.
Share With Heart Patients
The combined ten-year-long study showed that CABG along with standard medical therapy resulted in much lower mortality (death rate) and subsequent hospitalization.
These results will eventually lead to much improved treatment for many formerly hopeless heart patients as they percolate down the medical chain of command and reach doctors.
That’s why you need to share this with any heart patients you know so they can inform their cardiologists.
“Our results usher in a new era in the treatment of coronary artery disease because we now have evidence that with CABG and medical therapy, there is a 16 percent reduction in the risk of death from any cause over 10 years,” Dr. Velazquez said.
There was also a big benefit for those who didn’t survive 10 years – specifically. their lives were extended by nearly 18 months on average.
Scientifically Rigorous Study
“Conducting this trial was critically important to determine in a scientifically rigorous study that CABG improves survival for individuals with coronary artery disease and compromised left ventricular function,” said NHLBI Director Gary H. Gibbons, MD.
“The current 10-year follow-up provides new important insights about patient subgroups that are more likely to benefit from CABG as compared to medical therapy alone. As such, we now have a solid evidence base to inform patient care and the future development of clinical practice recommendations.”
The investigation was published in the April 2016 New England Journal of Medicine and is one of very few cardiovascular trials that extended over 10 years and with approximately 98 percent of the patients followed through the end of the study.
“‘It is unusual to have this quality of follow-up for so long,’ said Dr. Sopko. ‘It speaks to the rigor of the results.’ He added that the results are very generalizable, as the study included a diverse patient population spread across 22 countries and various health systems.”
