J-SAP study 1-2: outcomes of patients with stable high-risk coronary artery disease receiving medical-preceding therapy in Japan.
BACKGROUND
Stable coronary artery disease (CAD) is classified into 2 types: high-risk (ie, 3-vessel disease, left main trunk lesions, or ostial lesions of the left anterior descending (LAD)) and low-risk (1- or 2-vessel disease other than ostial lesions of the LAD). Generally, the former is treated with coronary artery bypass grafting-preceding therapy (CABG), but not medical-preceding therapy (Medical); however, this is based on evidence from 30 years ago or more and does not reflect the recent progression of Medical and CABG. In addition, a randomized study has not been performed in Japan.


RESULTS
In high-risk CAD, the long-term outcomes of 77 Medical patients and age-, sex-, coronary-lesion-, symptom- and risk-factor-matched 99 CABG patients were surveyed over 3 years (mean: 3.4 years) starting in 2000 at 37 nationwide hospitals. The incidences of cardiac death and cardiac death+non-fatal acute coronary syndrome (9.1% and 11.7% in Medical, and 2.0% and 3.0% in CABG, respectively) were significantly higher and the improvement in clinical symptoms was significantly lower in Medical than CABG.


CONCLUSIONS
CABG is recommended in patients with high-risk CAD from the view of long-term prognosis; however, it should be remembered that the long-term outcome in Medical has considerably improved.
Fukunishi
Masanori
M
Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Japan.
Nishigaki
Kazuhiko
K
Okubo
Munenori
M
Kawasaki
Masanori
M
Takemura
Genzou
G
Minatoguchi
Shinya
S
Fujiwara
Hisayoshi
H
D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000191:economics; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011897:Random Allocation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome