Late results of surgical and medical therapy for patients with coronary artery disease and depressed left ventricular function

Late survival and freedom from myocardial infarction were determined for 192 patients with coronary artery disease and depressed left ventricular ejection fraction at rest (less than or equal to 35%) determined by biplane angiography who were evaluated between 1970 and 1977. Seventy-seven patients had coronary artery bypass grafting and 115 patients were treated medically and were considered surgical candidates. The medical and surgical groups were comparable in all baseline characteristics examined except frequency of three vessel disease and angina pectoris, which occurred in a significantly greater percent of the surgically treated patients (p less than 0.01). Only three medically treated patients (2.6%) underwent coronary bypass grafting in the follow-up period. Seven year actuarial survival was 63% in the surgical and 34% in the medical group (p less than 0.001). Ninety-three percent of patients in the surgical group and 81% of those in the medical group were free of nonfatal myocardial infarction (p = 0.01), and 62 and 33%, respectively, were alive and free of myocardial infarction (p less than 0.001) at 7 years. Significant differences in survival favoring surgical treatment were observed for the subsets of patients with an ejection fraction of 25% or less (p = 0.0002) and 26 to 35% (p = 0.01), and for the subsets with three vessel coronary disease (p less than 0.001), normal left ventricular end-diastolic volume (less than or equal to 100 ml/m2) (p = 0.005) and elevated end-diastolic volume (greater than 100 ml/m2)(p = 0.001). After adjustment for other important prognostic variables, the type of treatment remained significant in predicting the relative risk (medical to surgical) of mortality at 5 and 7 years (2.58 and 2.12, respectively). These data corroborate the trends observed in several randomized trials of medical and surgical therapy in patients with abnormal left ventricular function. If hospital mortality for coronary artery bypass grafting is less than 5%, substantial benefit can be anticipated for the majority of patients with depressed ventricular function.

This article has been cited by other articles:

				P. Nardi, A. Pellegrino, A. Scafuri, D. Colella, C. Bassano, P. Polisca, and L. Chiariello Long-term outcome of coronary artery bypass grafting in patients with left ventricular dysfunction. Ann. Thorac. Surg., May 1, 2009; 87(5): 1401 - 1407. [Abstract] [Full Text] [PDF]

				C. F. Chong, A. A. Fazuludeen, C. Tan, M. Da Costa, P. S. Wong, and C. N. Lee Surgical Coronary Revascularization in Severe Left Ventricular Dysfunction Asian Cardiovasc Thorac Ann, February 1, 2007; 15(1): 14 - 18. [Abstract] [Full Text] [PDF]

				J J Bax, E E van der Wall, and M Harbinson Radionuclide techniques for the assessment of myocardial viability and hibernation Heart, August 1, 2004; 90(suppl_5): v26 - v33. [Full Text] [PDF]

				S. Sawada, A. Bapat, D. Vaz, J. Weksler, N. Fineberg, A. Greene, I. Gradus-Pizlo, and H. Feigenbaum Incremental value of myocardial viability for prediction of Long-Term prognosis in surgically revascularized patients with left ventricular dysfunction J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2099 - 2105. [Abstract] [Full Text] [PDF]

				P. J. Shah, D. L. Hare, J. S. Raman, I. Gordon, R. K. Chan, J. D. Horowitz, A. Rosalion, and B. F. Buxton Survival after myocardial revascularization for ischemic cardiomyopathy: A prospective ten-year follow-up study J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1320 - 1327. [Abstract] [Full Text] [PDF]

				P E Antunes, J M F. de Oliveira, and M J Antunes Coronary surgery with non-cardioplegic methods in patients with advanced left ventricular dysfunction: immediate and long term results Heart, April 1, 2003; 89(4): 427 - 431. [Abstract] [Full Text] [PDF]

				F. C. Visser Prediction of Surgical Treatment Effect by Preoperative Imaging:Present and Future Perspectives Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 31 - 36. [PDF]

				J. Meluzin, J. Cerny, L. Spinarova, J. Toman, L. Groch, F. Stetka, M. Frelich, P. Hude, J. Krejci, L. Rambouskova, et al. Prognosis of patients with chronic coronary artery disease and severe left ventricular dysfunction. The importance of myocardial viability Eur J Heart Fail, January 1, 2003; 5(1): 85 - 93. [Abstract] [Full Text] [PDF]

				A. Gimelli, J. A. M. Neto, C. Marcassa, P. Ferrazzi, M. Glauber, and P. Marzullo Beneficial effects of coronary revascularization in patients with ischaemic left ventricular dysfunction with and without anginal symptoms Interactive CardioVascular and Thoracic Surgery, September 1, 2002; 1(1): 9 - 15. [Abstract] [Full Text] [PDF]

				R. Lorusso, G. La Canna, C. Ceconi, V. Borghetti, P. Totaro, G. Parrinello, G. Coletti, and G. Minzioni Long-term results of coronary artery bypass grafting procedure in the presence of left ventricular dysfunction and hibernating myocardium Eur. J. Cardiothorac. Surg., November 1, 2001; 20(5): 937 - 948. [Abstract] [Full Text] [PDF]

				G. D. Veenhuyzen, S. N. Singh, D. McAreavey, B. J. Shelton, and D. V. Exner Prior Coronary Artery Bypass Surgery and Risk of Death Among Patients With Ischemic Left Ventricular Dysfunction Circulation, September 25, 2001; 104(13): 1489 - 1493. [Abstract] [Full Text] [PDF]

				M E Lewis, M P. Pitt, and R S Bonser Surgical alternatives to mechanical support Perfusion, July 1, 2000; 15(4): 379 - 386. [PDF]

				L. L. Mickleborough, S. Carson, M. Tamariz, and J. Ivanov RESULTS OF REVASCULARIZATION IN PATIENTS WITH SEVERE LEFT VENTRICULAR DYSFUNCTION J. Thorac. Cardiovasc. Surg., March 1, 2000; 119(3): 550 - 557. [Abstract] [Full Text] [PDF]

				R J Trent, G D Waiter, G S Hillis, F I McKiddie, T W Redpath, and S Walton Dobutamine magnetic resonance imaging as a predictor of myocardial functional recovery after revascularisation Heart, January 1, 2000; 83(1): 40 - 46. [Abstract] [Full Text] [PDF]

				R. Senior, S. Kaul, and A. Lahiri Myocardial viability on echocardiography predicts long-term survival after revascularization in patients with ischemic congestive heart failure J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1848 - 1854. [Abstract] [Full Text] [PDF]

				R. W. Morse, S. Noe, J. Caravalho Jr., A. Balingit, and A. J. Taylor Rest-Redistribution 201Tl Single-Photon Emission CT Imaging for Determination of Myocardial Viability: Relationship Among Viability, Mode of Therapy, and Long-term Prognosis Chest, June 1, 1999; 115(6): 1621 - 1626. [Abstract] [Full Text] [PDF]

				D PAGANO, J N TOWNEND, and R S BONSER What is the role of revascularisation in ischaemic heart failure? Heart, January 1, 1999; 81(1): 8 - 9. [Full Text]

				M. F. Di Carli, J. Maddahi, S. Rokhsar, H. R. Schelbert, D. Bianco-Batlles, R. C. Brunken, and B. Fromm LONG-TERM SURVIVAL OF PATIENTS WITH CORONARY ARTERY DISEASE AND LEFT VENTRICULAR DYSFUNCTION: IMPLICATIONS FOR THE ROLE OF MYOCARDIAL VIABILITY ASSESSMENT IN MANAGEMENT DECISIONS J. Thorac. Cardiovasc. Surg., December 1, 1998; 116(6): 997 - 1004. [Abstract] [Full Text] [PDF]

				G. D. Trachiotis, W. S. Weintraub, T. S. Johnston, E. L. Jones, R. A. Guyton, and J. M. Craver Coronary artery bypass grafting in patients with advanced left ventricular dysfunction Ann. Thorac. Surg., November 1, 1998; 66(5): 1632 - 1639. [Abstract] [Full Text] [PDF]

				J. Meluzin, J. Cerny, M. Frelich, F. Stetka, L. Spinarova, J. Popelova, R. Stipal, and on behalf of the Investigators of This Multicenter Prognostic value of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease and left ventricular dysfunction J. Am. Coll. Cardiol., October 1, 1998; 32(4): 912 - 920. [Abstract] [Full Text] [PDF]

				R. D. Anderson, E. M. Ohman, D. R. Holmes Jr., R. A. Harrington, G. W. Barsness, N. M. Wildermann, H. R. Phillips, E. J. Topol, and R. M. Califf Prognostic value of congestive heart failure history in patients undergoing percutaneous coronary interventions J. Am. Coll. Cardiol., October 1, 1998; 32(4): 936 - 941. [Abstract] [Full Text] [PDF]

				A. N. Kitsiou, G. Srinivasan, A. A. Quyyumi, R. M. Summers, S. L. Bacharach, and V. Dilsizian Stress-Induced Reversible and Mild-to-Moderate Irreversible Thallium Defects : Are They Equally Accurate for Predicting Recovery of Regional Left Ventricular Function After Revascularization? Circulation, August 11, 1998; 98(6): 501 - 508. [Abstract] [Full Text] [PDF]

				W. Wijns, S. F. Vatner, and P. G. Camici Hibernating Myocardium N. Engl. J. Med., July 16, 1998; 339(3): 173 - 181. [Full Text] [PDF]

				A. Yamaguchi, T. Ino, H. Adachi, S. Murata, H. Kamio, M. Okada, and J.-i. Tsuboi Left Ventricular Volume Predicts Postoperative Course in Patients With Ischemic Cardiomyopathy Ann. Thorac. Surg., February 1, 1998; 65(2): 434 - 438. [Abstract] [Full Text] [PDF]

				M. Gheorghiade and R. O. Bonow Chronic Heart Failure in the United States : A Manifestation of Coronary Artery Disease Circulation, January 27, 1998; 97(3): 282 - 289. [Full Text] [PDF]

				M. Jahangiri, J. Wright, S. Edmondson, and P. Magee Coronary artery bypass graft surgery in dialysis patients Heart, October 1, 1997; 78(4): 343 - 345. [Abstract] [Full Text] [PDF]

				L. L. Mickleborough, H. Maruyama, Y. Takagi, S. Mohamed, Z. Sun, and L. Ebisuzaki Results of Revascularization in Patients With Severe Left Ventricular Dysfunction Circulation, November 1, 1995; 92(9): 73 - 79. [Abstract] [Full Text]

				A. Yamaguchi, T. Ino, H. Adachi, A. Mizuhara, S. Murata, and H. Kamio Left Ventricular End-Systolic Volume Index in Patients With Ischemic Cardiomyopathy Predicts Postoperative Ventricular Function Ann. Thorac. Surg., October 1, 1995; 60(4): 1059 - 1062. [Abstract] [Full Text]

				N. M. Cohen, R. J. Damiano Jr, and A. S. Wechsler Is There an Alternative to Potassium Arrest? Ann. Thorac. Surg., September 1, 1995; 60(3): 858 - 863. [Abstract] [Full Text]

				D. W. Baker, R. Jones, J. Hodges, B. M. Massie, M. A. Konstam, and E. A. Rose Management of Heart Failure: III. The Role of Revascularization in the Treatment of Patients With Moderate or Severe Left Ventricular Systolic Dysfunction JAMA, November 16, 1994; 272(19): 1528 - 1534. [Abstract] [PDF]

				O. N. Nwasokwa, J. H. Koss, G. H. Friedman, A. M. Grunwald, and M. M. Bodenheimer Bypass Surgery for Chronic Stable Angina: Predictors of Survival Benefit and Strategy for Patient Selection Ann Intern Med, June 1, 1991; 114(12): 1035 - 1049. [Abstract] [PDF]

				R. M. Califf, F. E. Harrell Jr, K. L. Lee, J. S. Rankin, M. A. Hlatky, D. B. Mark, R. H. Jones, L. H. Muhlbaier, H. N. Oldham Jr, and D. B. Pryor The Evolution of Medical and Surgical Therapy for Coronary Artery Disease: A 15-Year Perspective JAMA, April 14, 1989; 261(14): 2077 - 2086. [Abstract] [PDF]