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Fremes","Professor of Surgery, University of Toronto",[794,797],{"name":795,"class":796},"Canadian Institutes of Health Research (CIHR)","OTHER_GOV",{"name":798,"class":6},"Weill Medical College of Cornell University","100472091","the-canadian-cabg-or-pci-in-patients-with-ischemic-cardiomyopathy-trial-stich3c-100472091",false,"NCT05427370","The Canadian CABG or PCI in Patients With Ischemic Cardiomyopathy Trial (STICH3C)","The Canadian CABG or PCI in Patients With Ischemic Cardiomyopathy Trial","Inclusion Criteria:\n\n1. Age \\>18 years;\n2. LVEF ≤40% quantified by either echocardiography, SPECT ventriculography, or magnetic resonance within 2 months of randomization;\n3. Prognostically important multivessel CAD (triple vessel CAD or double vessel disease including the left anterior descending (LAD) or LM). Significant coronary stenosis is defined as ≥ 70% based on coronary angiography, and\u002For fractional flow reserve (FFR) ≤0.80 or instantaneous wave-free ratio (iFR) ≤0.89. For LM disease, significant coronary stenosis is defined as \\>50% based on coronary angiography, intravascular ultrasound (IVUS) minimal luminal area (MLA) ≤6.0 mm2 (\\\u003C4.5 mm2 Asian descent), or equivalent optical coherence tomography (OCT) measurements;\n4. The institutional Heart Team agrees that guideline-directed medical therapy (GDMT) has been initiated for ≥1 month in prevalent and newly diagnosed cases. In patients hospitalized with newly diagnosed iLVSD (with or without acute coronary syndrome (ACS)) requiring revascularization before discharge, GDMT needs to be initiated, when possible in-hospital before randomization, with the expectation that it will be titrated to maximally tolerated doses after revascularization;\n5. Signed informed consent.\n\nExclusion Criteria:\n\n1. Decompensated HF requiring inotropic\u002Fadrenergic support, invasive or non-invasive ventilation or intra-aortic balloon pump\u002Fventricular assist device therapy less than 48 hours prior to randomization;\n2. Recent (\\\u003C4 weeks) ST-elevation MI;\n3. Concomitant severe valvular disease or other condition such as left ventricular aneurysm requiring surgical repair or replacement;\n4. Planned major concomitant surgical procedures (LAAO and AF ablation surgical procedures permitted);\n5. Prior PCI within the past 12 months (to reduce restenosis events from prior PCIs contributing to the primary outcome);\n6. Prior cardiac surgery;\n7. Prohibitive bleeding risk mandating avoidance of dual antiplatelet therapy;\n8. Circumstances likely to lead to poor treatment adherence;\n9. Severe end-organ dysfunction (such as dialysis, liver failure, respiratory failure, cancer) that reduces life expectancy to less than 5 years;\n10. Current pregnancy;\n11. Patient not amenable to both CABG or PCI according to the Heart Team;\n12. Takotsubo\u002FTakotsubo Cardiomyopathy\u002FBroken Heart Syndrome.","ALL","18 Years",{"count":809,"type":810},754,"ESTIMATED","INTERVENTIONAL",[813],"NA","The Canadian CABG or PCI in Patients With Ischemic Cardiomyopathy (STICH3C) trial is a prospective, unblinded, international multi-center randomized trial of 754 subjects enrolled in approximately 45 centers comparing revascularization by percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with multivessel\u002Fleft main (LM) coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF).\n\nThe primary objective is to determine whether CABG compared to PCI is associated with a reduction in all-cause death, stroke, spontaneous myocardial infarction (MI), urgent repeat revascularization (RR), or heart failure (HF) readmission over a median follow-up of 5 years in patients with multivessel\u002FLM CAD and ischemic left ventricular dysfunction (iLVSD).\n\nEligible patients are considered by the local Heart Team appropriate and amenable for non-emergent revascularization by both modes of revascularization.\n\nThe secondary objectives are to describe the early risks of both procedures, and a comprehensive set of patient-reported outcomes longitudinally.",[816,817],"Coronary Artery Disease","Heart Failure Systolic",[819,820,821,822],"Left ventricular dysfunction","CABG","PCI","MACCE","2026-04-27",{"date":825,"type":826},"2026-04-28","ACTUAL",{"date":828,"type":826},"2023-06-22",{"date":830,"type":810},"2029-12",{"name":5,"class":6},43]