title: Long-term survival of patients with ischemic cardiomyopathy treated by coronary artery bypass grafting versus medical therapy.
abstract: BACKGROUND
  We prospectively applied the Surgical Treatment of Ischemic Cardiomyopathy trial entry criteria to an observational database to determine whether coronary artery bypass grafting (CABG) decreases mortality compared with medical therapy (MED) for patients with coronary artery disease and depressed left ventricular ejection fraction.
  
  
  METHODS
  This was a retrospective, observational, cohort study of prospectively collected data from the Duke Databank for Cardiovascular Disease. Long-term mortality was the main outcome measure. Between January 1, 1995, and July 31, 2009, 86,874 patients underwent cardiac catheterization for suspected ischemic heart disease and were evaluated for inclusion in the analysis.
  
  
  RESULTS
  A total of 2,624 patients were found to have left ventricular ejection fraction less than 0.35, coronary artery disease amenable to CABG, and no left main stenosis of greater than 50%. After exclusions including ongoing Canadian Cardiovascular Society class III angina and acute myocardial infarction, 763 patients were included for propensity score analysis, including 624 who received MED and 139 who underwent CABG. Adjusted mortality curves were constructed for those patients in the three quintiles most likely to receive CABG. The curves diverged early, with risk-adjusted mortality rates at 5 years of 46% for MED versus 29% for CABG, and the survival benefit of CABG over MED continued through 10 years of follow-up (hazard ratio, 0.63; 95% confidence interval, 0.45 to 0.88).
  
  
  CONCLUSIONS
  Among a propensity-matched, risk-adjusted, observational cohort of patients with coronary artery disease, left ventricular ejection fraction less than 0.35, and no left main disease of greater than 50%, CABG is associated with a survival advantage over MED through 10 years of follow-up.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina 27715, USA. eric.velazquez@duke.edu
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Judson B
authors.initials: JB
authors.lastname: Williams
authors.forename: Eric
authors.initials: E
authors.lastname: Yow
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Harry R
authors.initials: HR
authors.lastname: Phillips
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.forename: Robert H
authors.initials: RH
authors.lastname: Jones
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000453:epidemiology; D008955:Models, Cardiovascular; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D009657:North Carolina / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents