Hassanabad Ali Fatehi, MacQueen Kelsey T, Ali Imtiaz
Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Faculty of Medicine, University of Calgary, Calgary, Canada.
J Card Surg. 2019 Oct;34(10):1075-1082. doi: 10.1111/jocs.14166. Epub 2019 Aug 2.
Coronary artery disease (CAD) is a significant source of morbidity and mortality in developed countries. The landmark Surgical Treatment for Ischemic Heart Failure (STICH) trial has provided greatly needed evidence in the management of patients with severe left ventricle (LV) dysfunction (LVEF ≤ 35%) and CAD amenable to revascularization. The trial investigated two primary hypotheses: (i) that coronary artery bypass grafting (CABG) with optimal medical therapy (OMT) was superior to OMT alone, and (ii) that CABG with surgical ventricular reconstruction (SVR) would be superior to CABG alone. The results of the 10-year follow-up demonstrated significant long-term benefits with the addition of CABG to OMT. However, the second hypothesis yielded controversial results as the study found no difference between CABG with SVR and SVR alone. The STICH trial, and the numerous subanalyses that followed have reinforced and challenged a number of widely held beliefs regarding the management of patients with severe LV dysfunction and ischemic heart failure. The purpose of this comprehensive review is to outline the published data from the STICH trial and its substudies while providing a balanced assessment of the evidence-based conclusions and criticisms that have followed.
冠状动脉疾病（CAD）是发达国家发病和死亡的重要原因。具有里程碑意义的缺血性心力衰竭外科治疗（STICH）试验为重度左心室（LV）功能不全（左心室射血分数[LVEF]≤35%）且适合血运重建的CAD患者的管理提供了急需的证据。该试验研究了两个主要假设：（i）冠状动脉旁路移植术（CABG）联合最佳药物治疗（OMT）优于单纯OMT，以及（ii）CABG联合外科心室重建（SVR）优于单纯CABG。10年随访结果表明，OMT加CABG具有显著的长期益处。然而，第二个假设产生了有争议的结果，因为研究发现CABG联合SVR与单纯SVR之间没有差异。STICH试验以及随后的大量亚组分析强化并挑战了一些关于重度LV功能不全和缺血性心力衰竭患者管理的广泛观点。本综述的目的是概述STICH试验及其子研究发表的数据，同时对随后基于证据得出的结论和批评进行全面评估。
