title: Long-term analysis of left ventricular ejection fraction in patients with stable multivessel coronary disease undergoing medicine, angioplasty or surgery: 10-year follow-up of the MASS II trial.
abstract: BACKGROUND
  Assuming that coronary interventions, both coronary bypass surgery (CABG) and percutaneous coronary intervention (PCI), are directed to preserve left ventricular function, it is not known whether medical therapy alone (MT) can achieve this protection. Thus, we evaluated the evolution of LV ejection fraction (LVEF) in patients with stable coronary artery disease (CAD) treated by CABG, PCI, or MT as a post hoc analysis of a randomized controlled trial with a follow-up of 10 years.
  
  
  METHODS
  Left ventricle ejection fraction was assessed with transthoracic echocardiography in patients with multivessel CAD, participants of the MASS II trial before randomization to CABG, PCI, or MT, and re-evaluated after 10 years of follow-up.
  
  
  RESULTS
  Of the 611 patients, 422 were alive after 10.32 ± 1.43 years. Three hundred and fifty had LVEF reassessed: 108 patients from MT, 111 from CABG, and 131 from PCI. There was no difference in LVEF at the beginning (0.61 ± 0.07, 0.61 ± 0.08, 0.61 ± 0.09, respectively, for PCI, CABG, and MT, P = 0.675) or at the end of follow-up (0.56 ± 0.11, 0.55 ± 0.11, 0.55 ± 0.12, P = 0.675), or in the decline of LVEF (reduction delta of -7.2 ± 17.13, -9.08 ± 18.77, and -7.54 ± 22.74). Acute myocardial infarction (AMI) during the follow-up was associated with greater reduction in LVEF. The presence of previous AMI (OR: 2.50, 95% CI: 1.40-4.45; P = 0.0007) and during the follow-up (OR: 2.73, 95% CI: 1.25-5.92; P = 0.005) was associated with development of LVEF <45%.
  
  
  CONCLUSIONS
  Regardless of the therapeutic option applied, LVEF remains preserved in the absence of a major adverse cardiac event after 10 years of follow-up.
  
  
  BACKGROUND
  http://www.controlled-trials.com. Registration number ISRCTN66068876.
authors.affiliation: Department of Atherosclerosis, Heart Institute of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo/SP 05403-000, Brazil.
authors.forename: Cibele Larrosa
authors.initials: CL
authors.lastname: Garzillo
authors.forename: Whady
authors.initials: W
authors.lastname: Hueb
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Eduardo Gomes
authors.initials: EG
authors.lastname: Lima
authors.forename: Paulo Cury
authors.initials: PC
authors.lastname: Rezende
authors.forename: Alexandre Ciappina
authors.initials: AC
authors.lastname: Hueb
authors.forename: Ricardo D'Oliveira
authors.initials: RD
authors.lastname: Vieira
authors.forename: Desiderio
authors.initials: D
authors.lastname: Favarato
authors.forename: Alexandre Costa
authors.initials: AC
authors.lastname: Pereira
authors.forename: Paulo Rogério
authors.initials: PR
authors.lastname: Soares
authors.forename: Carlos Vicente
authors.initials: CV
authors.lastname: Serrano
authors.forename: José Antônio Franchini
authors.initials: JA
authors.lastname: Ramires
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology; D009204:Myocardial Revascularization / Q000379:methods; D062645:Percutaneous Coronary Intervention; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology
chemical_list: D002317:Cardiovascular Agents
keywords: Coronary artery disease; Coronary bypass surgery; Left ventricular ejection fraction; Medical therapy; Percutaneous coronary intervention