Viability by MRI or PET Would Have Changed the Results of the STICH Trial

The Surgical Treatment for Ischemic Heart Failure (STICH) trial found that viability assessment did not identify patients with a survival advantage from coronary artery bypass grafting (CABG) compared to medical therapy. STICH viability testing was performed with single-photon emission computed tomography (SPECT) myocardial perfusion imaging, dobutamine echocardiography, or both. There has been controversy regarding the strength of the conclusions, and whether newer technologies such as cardiac magnetic resonance (CMR) or position emission tomography imaging (PET) would have changed the results. Improvements in medical therapy for heart failure over the past decade have led to decreased incremental benefit of revascularization therapy over medical therapy alone, as demonstrated by primary STICH findings. Although weaknesses in study design and performance limit generalizability, likely more precise techniques such as CMR or PET were needed to discern the smaller incremental survival benefit that may be afforded with CABG compared to medical therapy for ischemic cardiomyopathy.