Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy
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Key result
Surgical ventricular reconstruction added to CABG showed no overall benefit for death or cardiac hospitalization (HR 0.99), but subgroup analyses suggested potential benefit in patients with less dilated left ventricles (LVESVI <60 mL/m2) and harm in those with larger ventricles (>90 mL/m2).
Why the study?
Does surgical ventricular reconstruction added to CABG improve clinical outcomes in specific subgroups of patients with ischaemic cardiomyopathy based on baseline LV function?
Population
1000 patients with ischaemic cardiomyopathy enrolled in the STICH trial, with baseline left ventricular…
Comparison
Surgical ventricular reconstruction added to… vs Coronary artery bypass grafting (CABG) alone
Design
RCT, randomized arms
Authors
Discussion
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Implication
Adds no benefit to CABG overall with potential harm in large ventricles; challenges routine use and leaves subgroup benefit open to confirmation.
Study Design
Type
RCT (n=1,000)
Blinding
Blinded Core Labs for imaging assessment
Randomization
Randomized in equal proportions
Multicenter
Yes
Structured PICO
Does surgical ventricular reconstruction added to CABG improve clinical outcomes in specific subgroups of patients with ischaemic cardiomyopathy based on baseline LV function?
P
Population
1,000 patients with ischaemic cardiomyopathy (LVEF ≤35%) and anterior akinesia or dyskinesia amenable to SVR, followed for a median of 4 years.
I
Intervention
Surgical ventricular reconstruction (SVR) added to coronary artery bypass grafting (CABG)
C
Comparator
Coronary artery bypass grafting (CABG) alone
O
Outcome
Clinical outcome (not explicitly defined in abstract)
Main Result
Hazard Ratio: 0.99 (95% CI 0.82–1.21)
p-value: p=0.95
In patients with ischaemic cardiomyopathy, surgical ventricular reconstruction added to CABG may benefit those with less dilated left ventricles and better ejection fraction, but may be harmful in those with larger ventricles and poorer ejection fraction.
Limitations
- A single Core Lab assessment of LV global and regional function measures was not available in every patient.
- Mixing of different imaging modalities in LV volume measurements introduces measurement variability.
- The impact of the amount of LV volume reduction by SVR on the clinical outcome was not assessed.
- The results are based on subgroup analyses of the overall study population, requiring cautious interpretation.
Cite This Study
Oh et al. (2012) conducted an RCT in Ischaemic cardiomyopathy (n=1,000). Surgical ventricular reconstruction (SVR) added to CABG vs. CABG alone was evaluated on Death or cardiac hospitalization (HR 0.99, 95% CI 0.82-1.21, p=0.95). Surgical ventricular reconstruction added to CABG showed no overall benefit for death or cardiac hospitalization (HR 0.99), but subgroup analyses suggested potential benefit in patients with less dilated left ventricles (LVESVI <60 mL/m2) and harm in those with larger ventricles (>90 mL/m2).
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