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Comment & Response
October 12, 2022

Is CABG Indicated in Patients With Ischemic Cardiomyopathy?—Reply

Author Affiliations
  • 1Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
JAMA Cardiol. 2022;7(11):1177. doi:10.1001/jamacardio.2022.3312

In Reply We thank Bates for his interest in our article.1 We agree that despite the separate acronym of STICHES, the 2016 publication is the report of the 10-year results of the Surgical Treatment for Ischemic Heart Failure (STICH) trial.2 In the original 2011 publication,3 at a median follow-up of 4.7 years, 244 patients in the medical therapy arm died compared with 218 patients in the coronary artery bypass grafting (CABG) arm (hazard ratio [HR], 0.86; 95% CI, 0.72-1.04; P = .12). Although the difference in all-cause mortality was not statistically significant in the primary analysis, the reduction in cardiovascular death (HR, 0.81; 95% CI, 0.66-1.00; P = .05) and the reduction in the composite of all-cause mortality or hospitalization for cardiovascular causes (HR, 0.74; 95% CI, 0.64-0.85; P < .001) with CABG were both statistically significant. With extension of follow-up to a median of 9.8 years, the reduction in all-cause mortality with CABG was now statistically significant (HR, 0.84; 95% CI, 0.73-0.97; P = .02). This benefit emerging over longer follow-up has several plausible explanations: extending follow-up leads to accrual of more events, enhancing precision around point estimates and narrowing the CIs. Furthermore, time-varying analyses show an early mortality hazard with CABG. Longer follow-up helps account for this phenomenon and permits the durable and significant benefit of CABG to be shown.

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