TY  - JOUR
AU  - Wrobel, Krzysztof
AU  - Stevens, Susanna R.
AU  - Jones, Robert H.
AU  - Selzman, Craig H.
AU  - Lamy, Andre
AU  - Beaver, Thomas M.
AU  - Djokovic, Ljubomir T.
AU  - Wang, Nan
AU  - Velazquez, Eric J.
AU  - Sopko, George
AU  - Kron, Irving L.
AU  - DiMaio, J. Michael
AU  - Michler, Robert E.
AU  - Lee, Kerry L.
AU  - Yii, Michael
AU  - Leng, Chua Yeow
AU  - Zembala, Marian
AU  - Rouleau, Jean L.
AU  - Daly, Richard C.
AU  - Al-Khalidi, Hussein R.
PY  - 2015
UR  - https://vinar.vin.bg.ac.rs/handle/123456789/711
AB  - Background Patients with severe left ventricular dysfunction, ischemic heart failure, and coronary artery disease suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision making regarding whether to proceed to surgery difficult in such patients. To better inform such decision making, we analyzed the Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for detailed information on perioperative risk and outcomes. Methods and Results In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction of 35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy, or CABG with surgical ventricular reconstruction. Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients randomized to and receiving surgery, and 346 (approximate to 25%) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). Left ventricular size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. Conclusions CABG can be performed with relatively low 30-day mortality in patients with left ventricular dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.
T2  - Circulation
T1  - Influence of Baseline Characteristics, Operative Conduct, and Postoperative Course on 30-Day Outcomes of Coronary Artery Bypass Grafting Among Patients With Left Ventricular Dysfunction Results From the Surgical Treatment for Ischemic Heart Failure (STICH) Trial
VL  - 132
IS  - 8
SP  - 720
EP  - 730
DO  - 10.1161/CIRCULATIONAHA.114.014932
ER  - 

@article{
author = "Wrobel, Krzysztof and Stevens, Susanna R. and Jones, Robert H. and Selzman, Craig H. and Lamy, Andre and Beaver, Thomas M. and Djokovic, Ljubomir T. and Wang, Nan and Velazquez, Eric J. and Sopko, George and Kron, Irving L. and DiMaio, J. Michael and Michler, Robert E. and Lee, Kerry L. and Yii, Michael and Leng, Chua Yeow and Zembala, Marian and Rouleau, Jean L. and Daly, Richard C. and Al-Khalidi, Hussein R.",
year = "2015",
abstract = "Background Patients with severe left ventricular dysfunction, ischemic heart failure, and coronary artery disease suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision making regarding whether to proceed to surgery difficult in such patients. To better inform such decision making, we analyzed the Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for detailed information on perioperative risk and outcomes. Methods and Results In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction of 35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy, or CABG with surgical ventricular reconstruction. Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients randomized to and receiving surgery, and 346 (approximate to 25%) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). Left ventricular size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. Conclusions CABG can be performed with relatively low 30-day mortality in patients with left ventricular dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.",
journal = "Circulation",
title = "Influence of Baseline Characteristics, Operative Conduct, and Postoperative Course on 30-Day Outcomes of Coronary Artery Bypass Grafting Among Patients With Left Ventricular Dysfunction Results From the Surgical Treatment for Ischemic Heart Failure (STICH) Trial",
volume = "132",
number = "8",
pages = "720-730",
doi = "10.1161/CIRCULATIONAHA.114.014932"
}

Wrobel, K., Stevens, S. R., Jones, R. H., Selzman, C. H., Lamy, A., Beaver, T. M., Djokovic, L. T., Wang, N., Velazquez, E. J., Sopko, G., Kron, I. L., DiMaio, J. M., Michler, R. E., Lee, K. L., Yii, M., Leng, C. Y., Zembala, M., Rouleau, J. L., Daly, R. C.,& Al-Khalidi, H. R.. (2015). Influence of Baseline Characteristics, Operative Conduct, and Postoperative Course on 30-Day Outcomes of Coronary Artery Bypass Grafting Among Patients With Left Ventricular Dysfunction Results From the Surgical Treatment for Ischemic Heart Failure (STICH) Trial. in Circulation, 132(8), 720-730.
https://doi.org/10.1161/CIRCULATIONAHA.114.014932

Wrobel K, Stevens SR, Jones RH, Selzman CH, Lamy A, Beaver TM, Djokovic LT, Wang N, Velazquez EJ, Sopko G, Kron IL, DiMaio JM, Michler RE, Lee KL, Yii M, Leng CY, Zembala M, Rouleau JL, Daly RC, Al-Khalidi HR. Influence of Baseline Characteristics, Operative Conduct, and Postoperative Course on 30-Day Outcomes of Coronary Artery Bypass Grafting Among Patients With Left Ventricular Dysfunction Results From the Surgical Treatment for Ischemic Heart Failure (STICH) Trial. in Circulation. 2015;132(8):720-730.
doi:10.1161/CIRCULATIONAHA.114.014932 .

Wrobel, Krzysztof, Stevens, Susanna R., Jones, Robert H., Selzman, Craig H., Lamy, Andre, Beaver, Thomas M., Djokovic, Ljubomir T., Wang, Nan, Velazquez, Eric J., Sopko, George, Kron, Irving L., DiMaio, J. Michael, Michler, Robert E., Lee, Kerry L., Yii, Michael, Leng, Chua Yeow, Zembala, Marian, Rouleau, Jean L., Daly, Richard C., Al-Khalidi, Hussein R., "Influence of Baseline Characteristics, Operative Conduct, and Postoperative Course on 30-Day Outcomes of Coronary Artery Bypass Grafting Among Patients With Left Ventricular Dysfunction Results From the Surgical Treatment for Ischemic Heart Failure (STICH) Trial" in Circulation, 132, no. 8 (2015):720-730,
https://doi.org/10.1161/CIRCULATIONAHA.114.014932 . .