Comparison of effects of medical and surgical therapy on survival in severe angina pectoris and two-vessel coronary artery disease with and without left ventricular dysfunction: a Coronary Artery Surgery Study Registry Study.
This nonrandomized study compared the results of early coronary artery bypass grafting to those of initial medical therapy in a group of 2,023 patients with severe angina pectoris and 2 major epicardial coronary arteries having greater than or equal to 70% diameter luminal narrowing. Medical therapy was selected for 706 patients, and 1,317 patients were treated by coronary artery bypass grafting. The 6-year survival rate was 76% for patients treated medically and 89% for patients treated surgically (p less than 0.0001). Cox multivariate analysis showed that surgical treatment was a beneficial independent predictor of survival (p less than 0.001). For patients with 2-vessel coronary artery disease who had Canadian Heart Association class III and IV angina at presentation, surgical therapy provided a survival advantage for patients with impaired left ventricular function and proximal narrowing of 1 or more coronary arteries.
Mock
M B
MB
Mayo Clinic, Rochester, Minnesota 55905.
Fisher
L D
LD
Holmes
D R
DR
Gersh
B J
BJ
Schaff
H V
HV
McConney
M
M
Rogers
W J
WJ
Kaiser
G C
GC
Ryan
T J
TJ
Myers
W O
WO
D000208:Acute Disease; D000787:Angina Pectoris / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D009316:National Institutes of Health (U.S.); D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D014481:United States