STICH Found To Not Help
A stitch in time saves nine is an old adage, however, the surgical procedure called STICH was found to not be helpful in saving lives or reducing hospitalizations.
STICH stands for Surgical Treatment for Ischemic Heart Failure. It is a method of surgically remodeling swollen / enlarged ventricles in patients with ischemic heart failure.
Researchers have published the results of the Surgical Treatment for Ischemic Heart Failure trial in the New England Journal of Medicine. The study looked at whether STICH added to coronary artery bypass grafting (CABG) decreased the rate of death or hospitalization when compared to CABG alone. The researchers randomly assigned 1000 patients between September 2002 and January 2006 who had ejection fractions of 35% or less with coronary artery disease to one of the two groups. Only patients who had dominant anterior akinesia or dyskinesia of the left ventricle were considered to have disease that was amenable to surgical ventricular reconstruction.
STICH did reduce the end-systolic volume index by 19% compared to a reduction of only 6% in the patients who had the CABG only. Patients in the two groups had similar improvement in cardiac symptoms and exercise tolerance.
There was no reduction in the rate of death or hospitalization for cardiac causes between the two groups. "So bypass appears to be the dominant force producing these improvements," Dr. Michler said.
Jones RH, et al "Coronary bypass surgery with or without surgical ventricular reconstruction"; N Engl J Med 2009: 360: published online March 29, 2009.
Eisen HJ "Surgical ventricular reconstruction for heart failure"; N Engl J Med 2009; 360: published online March 29, 2009.