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.
Ahmad Y, Lansky AJ, Velazquez EJ. Is CABG Indicated in Patients With Ischemic Cardiomyopathy?—Reply. JAMA Cardiol. 2022;7(11):1177. doi:10.1001/jamacardio.2022.3312
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