MONDAY, April 4 (HealthDay News) -- At first glance, patients
suffering from heart failure because of blocked coronary arteries
appear to fare as well in terms of overall survival whether they
have bypass surgery or rely on medication alone, a new study seems
However, after a closer look, the researchers found that bypass
does reduce the risk of dying from heart disease, and also
the risk of death from any cause or hospitalization from heart
disease, by as much as 50 percent, compared with medication
"The trial supports bypass surgery on top of best medical therapy vs. best medical therapy alone to reduce cardiovascular morbidity and mortality," lead researcher Dr. Eric J. Velazquez, director of both the cardiac diagnostic unit and echocardiography laboratories at Duke University Medical Center, said during a Monday press conference.
Given these findings, heart failure patients who have never been
assessed for coronary-artery disease should be, he added.
The results of the study, called the Surgical Treatment of
Ischemic Heart Failure (STICH) trial, were presented Monday at the
American College of Cardiology's annual meeting, in New
For this multi-center study, 1,212 heart failure patients were
randomly assigned to medication alone or medical therapy plus
Over an average of five years of follow-up, the researchers
found that patients who underwent bypass surgery reduced their risk
of dying 14 percent compared with patients on medications alone.
However, that reduction was not statistically significant, the
Bypass surgery did, however, significantly reduce the risk of
dying from cardiovascular disease by 19 percent and the risk of
death from any cause and hospitalization for heart disease by 26
percent, Velazquez said.
Going over the data, the researchers found that 55 patients who
were supposed to have bypass surgery did not actually get the
procedure, and 100 patients assigned to medication alone ended up
having a bypass operation.
When the researchers straightened out these discrepancies, they
found bypass surgery actually reduced the risk of dying from any
cause by 30 percent to 50 percent compared with medication
This finding comes with some caveats: there were more risks from
bypass surgery than from medication alone. And, the survival
benefit of bypass surgery only kicked in two years after the
procedure, the researchers noted.
Two-thirds of the 6 million people in the United States with
heart failure have clogged coronary arteries, the researchers said.
Given the improvements in medical therapy, whether the risks of
bypass surgery are worth it has not been clear, the researchers
Bypass surgery involves taking healthy arteries and veins from
other parts of the body and using them to re-route blood around the
blockages, to restore blood flow and normal heart function. It has
been unclear whether the risks of bypass surgery were worth taking,
given recent lifesaving advances in medical therapy.
Dr. Gregg C. Fonarow, a professor of cardiology at the
University of California, Los Angeles, said that "the benefits and
risks of coronary-artery bypass surgery in patients with chronic
symptomatic heart failure have been uncertain and the results of
the STICH trial have been eagerly awaited."
"These important new findings suggest that surgical revascularization should be considered for patients with heart failure and coronary-artery disease," he said.
In addition to these findings, the STICH researchers used data
from the trial to look at whether imaging could identify patients
most likely to benefit from bypass surgery. Scans were given to 601
of the patients in the trial.
After almost five years of follow-up, the researchers found that
scans did not provide any clue to how effective bypass surgery
would be for each patient.
However, these scans, which can identify viable heart tissue,
were able to predict long-term survival. In fact, patients with
living heart tissue were 40 percent more likely to survive,
compared with patients with irreversible heart damage, the
For more on heart failure, visit the
American Heart Association.
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