Project 453040

Patients with blockages in the blood vessels that supply the heart muscle can develop heart failure due to a weak heart, a condition where the heart is unable to pump enough blood to supply the body's needs and often is associated with a build-up of fluid in the body. Patients with this condition are at high risk of future heart attacks, poor quality of life (shortness of breath and chest pain), hospitalizations and death. Patients with this condition are often referred for Coronary Artery Bypass Surgery (CABG) or Coronary Stenting to improve the circulation to the heart. CABG is an open-heart operation where healthy blood vessels from the patients are used to go around blockages caused by hardening of the arteries, like a detour (bypass). Stenting is a procedure where a small balloon is advanced into the heart blood vessels (either through a blood vessel in the wrist or the groin, similar to the angiogram) to directly open the blockage and then deliver a small wire mesh tube (stent) to keep the artery open. While more invasive, CABG is the standard treatment for patients with this condition and multiple blockages but with increased risk early after surgery of death and stroke. Stenting is less invasive, with faster recovery and generally safer in the short term but not be as effective long-term. There is no convincing evidence to say which approach is superior in these patients. STICH3C will determine in a sample size of 754 patients recruited from at least 45 centres in Canada and internationally, whether stenting or CABG is the best approach in these patients in terms of mortality, stroke and other cardiac outcomes over approximately 5 years. Patients will be assigned to stenting or CABG in STICH3C by chance, like flipping a coin. We also plan to evaluate patients' quality of life with the help of patient partners; and to share data with other international collaborators performing related studies in similar patient groups to generate even stronger evidence.