Compared to the conventional medical therapy, a combination of coronary artery bypass grafting (CABG) and medical therapy increases survival rate in patients with heart failure (HF). Results of the findings from a 10-year follow-up of Surgical Treatment for Ischemic Heart Failure (STICH) study were published by Velazquez and colleagues in the New England Journal of Medicine yesterday.
While CABG has been the mainstay of treatment in patients with advanced HF who do not respond to medical therapy, there has been but limited clinical trial data on its survival benefits over conventional medical therapy. However, the results published by Velazquez and co in the NEJM yesterday put a lot of things in perspective.
The report published in the renowned journal was the outcome of a 10-year follow-up of the Surgical Treatment for Ischemic Heart Failure (STITCH) study. The STITCH study was designed to assess the benefits of addition of CABG to medical therapy in terms of patient survival. The STICH trial confirmed the survival benefits of CABG over medical therapy in patients with HF with a follow-up of two years. The current results, however, are an extension of the STITCH study. The current findings reinforce the conclusion of the STITCH trial i.e., a combination of CABG and medical therapy is superior to medical therapy alone in terms of survival.
In the follow-up extension of STITCH, called STICHES, Velazquez and colleagues followed a total of 1,212 patients with an ejection fraction of ≤35%. The patients were randomly assigned to the CABG + medical therapy group or medical therapy alone group. The duration of the follow-up was 9.8 years. The primary outcome i.e., death, was lower in the CABG group (58.9%) as compared to the medical therapy group (66.1%). After the tenacious follow-up and close analysis, it was concluded that a combination of CABG and medical therapy confers a 10-year survival benefit in patients with ischemic cardiomyopathy, heart failure or any other cardiovascular disease.
What Is Heart Failure?
Heart failure is a medical condition in which the heart can either not fill up with sufficient blood or cannot pump enough blood to meet the body’s needs.
Heart failure does not mean the heart has stopped working; it means the heart is not pumping blood at the required rate and in the sufficient amount.
Heart failure is a serious condition that develops over years. It is a chronic condition that can affect either or both sides of the heart.
Right-sided heart failure occurs when the heart fails to pump sufficient blood to the lungs for oxygenation. Left-sided heart failure occurs when the heart fails to pump oxygenated blood to the rest of the body.
The most common causes of heart failure are prolonged diabetes, coronary heart disease, and hypertension.
Heart failure is quite common and affects 5.7 million Americans. It can affect both men and women, children and adults but elderly are at the highest risk of developing it.
What Is Coronary Artery Bypass Grafting (CABG)?
Coronary artery bypass grafting is the surgical repair of the defect in the heart to improve blood flow. The surgery is recommended in patients who do not respond to the medical therapy or have an extensive damage that usually occurs in coronary heart disease (CHD).
CHD is one of the most common causes of heart failure that develops over years. In CHD, plaque begins to build up in the arteries supplying blood to the heart, called the coronary arteries. The plaque is a hard substance that narrows the coronary arteries thereby reducing and/or blocking blood supply to the heart. A reduced blood supply to the heart can be signified as chest pain, called angina.
The plaque sometimes ruptures causing a complete blockade of the artery. When this happens, a heart attack ensues. CABG is one technique in which a healthy artery or vein from another body part is grafted to the blocked coronary artery in such a way that it bypasses the blocked portion and resumes the normal blood supply to the heart.
What Is The Medical Therapy For Heart Failure?
The medical therapy for HF is guided and almost universally prescribed in all HF patients. It includes:
- ACE Inhibitors – reduce blood pressure thereby reducing the force with which the ailing heart has to pump blood to the body.
- Angiotensin Receptor Blockers – work by relaxing the blood vessels. When the vessels are relaxed, the blood flow to and from the heart increases.
- Beta Blockers – work by slowing the heart rate and the blood pressure.
- Digoxin – increases the pumping power and the strength of the heart.
- Diuretics – reduce the fluid buildup in the lungs and the body due to poor heart function.
- Aldosterone Antagonists – remove the excess of sodium, the prime cause of high blood pressure, from the body through urine.
- Isosorbide Dinatrate and Hydralazine Hydrochloride – relax the blood vessels by a direct action.