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Objective To assess the effect of the addition of coronary artery bypass grafting (CABG) to medical therapy on mode of death in heart failure. Background While CABG therapy is widely used in ischemic cardiomyopathy patients, there is no prospective clinical trial data on mode of death. Methods The Surgical Treatment for Ischemic Heart Failure Trial (STICH) compared the strategy of CABG plus medical therapy to medical therapy alone in 1212 ischemic cardiomyopathy patients with reduced ejection fraction. A clinical events committee adjudicated deaths using pre-specified definitions for mode of death. Results In STICH, there were 462 deaths over a median follow-up of 56 months. The addition of CABG therapy tended to reduce cardiovascular deaths (HR 0.83; CI (0.68, 1.03),p=0.09) and significantly reduced the most common modes of death: sudden death (HR 0.73; CI (.54–.99) p=0.041) and fatal pump failure events (HR 0.64; CI (.41–1.00) p=0.05). Time-dependent estimates indicate that the protective effect of CABG principally occurred after 24 months in both categories. Deaths post- cardiovascular procedures were increased in CABG patients (HR 3.11 CI (1.47–6.60), but fatal myocardial infarction deaths were lower (HR 0.07 CI (0.01–0.57). Non- cardiovascular deaths were infrequent and did not differ between groups. Conclusion In STICH, the addition of CABG to medical therapy reduced the most common modes of death: sudden death and fatal pump failure events. The beneficial effects were principally seen after 2 years. Post-procedure deaths were increased in patients randomized to CABG while myocardial infarction deaths were decreased.