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J Thorac Cardiovasc Surg 2005;129:246-249
© 2005 The American Association for Thoracic Surgery

Editorials

To STICH or not to STICH: We know the answer, but do we understand the question?

^a Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany
^b Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
^c Duke Clinical Research Institute, Durham, NC
^d Division of Cardiothoracic Surgery, Ohio State University, Columbus, Ohio
^e Department of Cardiology and Cardiovascular Surgery, San Donato Hospital, Milano, Italy
^f Dedinje Cardiovascular Institute, Belgrade, Serbia

Received for publication June 11, 2004; revisions received July 26, 2004; accepted for publication July 30, 2004.

^* Address for reprints: Torsten Doenst, MD, Department of Cardiovascular Surgery, University of Freiburg, Hugstetter Str 55, 79106 Freiburg, Germany (E-mail: doenst@ch11.ukl.uni-freiburg.de).

The first 300 words of the full text of this article appear below.

	How would you treat this patient?

 
A 75-year-old 70-kg male patient reports having worsening shortness of breath over the past 2 years and now must stop to catch his breath after climbing 1 or 2 flights of stairs. He has no angina pectoris. He has electrocardiographic evidence of an old transmural anterior myocardial infarction. His comorbidities include hypertension and hyperlipidemia. Examination reveals some leg edema and an S3 gallop, but findings are otherwise unremarkable. The hemoglobin level is 150 g/L, and the creatinine value is 120 mg/L. An echocardiogram shows a moderately dilated left ventricle with anterior akinesia, mild mitral regurgitation, and an ejection fraction of 29%. Medications include angiotensin-converting enzyme inhibition, ß-blockade, a diuretic, and a statin. The coronary angiogram shows triple-vessel disease with an occluded left anterior descending artery and an occluded right coronary artery. Both vessels fill retrogradely from a large circumflex artery that has one high-grade stenosis in the obtuse marginal branch. All vessels are good targets for coronary artery bypass grafting (CABG). A fluorodeoxyglucose positron emission tomographic scan viability study reveals a scar in parts of the anterior wall and the apex and viability in the posterior wall and the septum.

View larger version (101K): [in this window] [in a new window]   Dr Doenst

The STICH (Surgical Treatment for IschemiC Heart failure) trial is the first prospective randomized study in the history of coronary artery surgery to specifically assess the potential benefit of CABG in patients with heart failure and coronary artery disease. The trial tests two hypotheses: (1) CABG combined with intensive medical therapy improves long-term survival compared with . . . [Full Text of this Article]