Revascularization and left ventricular reconstruction in a patient with ischemic heart failure: To STICH or not to STICH?

Abstract

The present chapter addresses the management of ischemic heart failure (HF) patients after the release of the Surgical Treatment for Ischemic Heart Failure (STICH) trial results. The STICH trial is a multicenter, international, randomized, non-blinded trial that started in 2002. The trial presents several flaws and has been largely criticized, therefore the question “to STICH or not to STICH” that reminds us of Shakespeare, still remains clinically relevant and the management of ischemic HF still represents a challenge. Enrollment criteria, patient's evaluation, patient selection, and imaging modalities are reviewed and discussed in the present chapter at the light of the results interpretation. One important issue, i.e., the “equipoise” of the investigator (equivalent risks and benefits) was introduced for ethical reasons but varying physician threshold for equipoise in the treatment assignment were permitted therefore, the characteristics of enrolled pts showed wide diversities in the 2,137 pts enrolled across the 127 participating, located in 27 countries, reflecting the experience of cardiologists and surgeons, the volume of operations in severely depressed cardiac function patients etc. This represents one major limitation/bias of the trial.