Quality-of-Life Outcomes in Surgical Treatment of Ischemic Heart Failure Quality-of-Life Outcomes With Coronary Artery Bypass Graft Surgery in Ischemic Left Ventricular Dysfunction: A Randomized Trial

Clinical trials performed during the 1970s and 1980s defined several major coronary artery disease (CAD) subgroups for which coronary artery bypass grafting (CABG) provided incremental survival, angina relief, or both relative to medical therapy, which formed the foundation for current practice patterns and guideline recommendations on the use of CABG (1-3). However, patients with severe left ventricular dysfunction (ejection fraction ≤0.35) were not represented in these early trials. Thus, management decisions for these patients have largely relied on clinical judgment to extrapolate from those trials and a small group of observational studies (4, 5). The challenges in using this evidence to select treatment for contemporary patients is further complicated in that medical therapies for both CAD and heart failure have improved substantially over those used in the earlier trials. The STICH (Surgical Treatment for Ischemic Heart Failure) trial was funded by the National Heart, Lung, and Blood Institute in 2002 to provide a comprehensive evaluation of the incremental therapeutic benefits of routine CABG over contemporary guideline-based medical therapy in patients with severe systolic dysfunction due to CAD (6). A major prespecified secondary end point of the trial was health-related quality of life (QOL), which is an outcome that complements the major clinical end points by assessing the patient’s experience of, and satisfaction with, the 2 therapeutic strategies compared (7, 8).