STICHMitral Regurgitation Subanalysis

Objective• Examine the relationship of mitral regurgitation (MR) severity and survival

and compare outcomes in patients with moderate–severe MR who did and did not receive mitral valve repair

Background• The STICH trial, which randomly assigned 1212 patients with LVEF <35%

to CABG or medical therapy alone, found no difference in all-cause mortality between these groups

• CABG was associated with reductions in some secondary endpoints, including the risk of CV death and the composite endpoint of all-cause mortality or CV hospitalization

• At baseline, MR was present in 64% of patients and classified as mild (46%) moderate (15%), and severe (3%); the decision to treat or not to treat MR was left to the surgeon

STICHMitral Regurgitation Subanalysis

Results• In the medical therapy group, mortality was higher in patients with

increasingly more severe MR; patients with moderate or severe MR had nearly double the risk of death from all causes as those with no or trace MR; patients with mild MR had a 60% increase in all-cause mortality

• In patients with no or trace MR, CABG was not associated with decreased mortality relative to medical therapy alone; however, CABG was associated with a reduced risk of death in patients with mild MR

• In the small subgroup of patients with moderate or severe MR (n=195), there was no survival advantage with CABG compared with medical therapy alone or with CABG and MV repair; however, after adjustment for baseline prognostic variables, the combination of CABG and MV repair was associated with a lower hazard of mortality compared with CABG alone and was associated with a trend toward lower mortality compared with medical therapy alone

STICHMitral Regurgitation Subanalysis

All-Cause Mortality Estimates for 195 Patients with Moderate/Severe MR

STICHMitral Regurgitation Subanalysis

Conclusions• In patients with moderate–severe MR, adding mitral repair to CABG

tends to decrease perioperative risk and increase survival compared with CABG alone or medical therapy alone

• In patients with severe LV dysfunction and mild MR, CABG alone improves survival

Trial Limitations• noncore lab assessment of MR• nonrandomized treatment• important baseline differences between those with and without

moderate– severe MR