title: Revascularization in severe ventricular dysfunction (15% < OR = LVEF < OR = 30%): a comparison of bypass grafting and percutaneous intervention.
abstract: BACKGROUND
  We sought to determine the optimal approach to revascularization of patients with severe left ventricular (LV) dysfunction.
  
  
  METHODS
  We conducted a single-center observational study of 117 consecutive patients who had severe LV dysfunction (15% < OR = LV ejection fraction < OR = 30%) and underwent either coronary artery bypass grafting (CABG, n = 69) or percutaneous revascularization (n = 48) between 1992 and 1997.
  
  
  RESULTS
  The CABG group was younger (62 versus 67 years, p = 0.026), and fewer previous bypasses (7% versus 40%, p < 0.0001) and fewer prior percutaneous revascularizations (16% versus 42%, p = 0.0019) were noted. More vessels were revascularized (3 +/- 0.8 versus 1.5 +/- 0.7, p < 0.0001), and revascularization was more complete by CABG (84% versus 48%, p < 0.0001). Morbidity and mortality at 30 days were similar, and there was no significant difference in 3-year survival (73% versus 67%), although 3-year cardiac event-free survival (52% versus 25%, p = 0.0011) and 3-year target vessel revascularization-free survival (71% versus 41%, p < 0.0001) were significantly better in the CABG group, and LV ejection fraction was significantly improved after CABG. In the subgroup of patients 65 years of age or older and those without proximal left anterior descending coronary artery lesions, significant benefit of CABG in cardiac event-free and target vessel revascularization-free survival disappeared.
  
  
  CONCLUSIONS
  We found that in clinically selected patients with severe ventricular dysfunction, CABG compared with percutaneous revascularization achieves more complete revascularization, improved LV function, fewer cardiac events, and fewer target vessel revascularizations, but does not affect mid-term survival. A prospective controlled trial with defined criteria for treatment assignment is warranted to confirm our results regarding the two revascularization strategies in patients with severe LV dysfunction.
authors.affiliation: Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana 07121, USA.
authors.forename: Koichi
authors.initials: K
authors.lastname: Toda
authors.forename: Karen
authors.initials: K
authors.lastname: Mackenzie
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: Charles J
authors.initials: CJ
authors.lastname: DiCorte
authors.forename: James E
authors.initials: JE
authors.lastname: Davis
authors.forename: P Michael
authors.initials: PM
authors.lastname: McFadden
authors.forename: John L
authors.initials: JL
authors.lastname: Ochsner
authors.forename: Christopher
authors.initials: C
authors.lastname: White
authors.forename: Clifford H
authors.initials: CH
authors.lastname: Van Meter
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000601:surgery*