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Comparative Study
. 2012 Feb;93(2):523-30.
doi: 10.1016/j.athoracsur.2011.10.064.

Long-term survival of patients with ischemic cardiomyopathy treated by coronary artery bypass grafting versus medical therapy

Eric J Velazquez  1 , Judson B Williams, Eric Yow, Linda K Shaw, Kerry L Lee, Harry R Phillips, Christopher M O'Connor, Peter K Smith, Robert H Jones
Affiliations
Comparative Study

Long-term survival of patients with ischemic cardiomyopathy treated by coronary artery bypass grafting versus medical therapy

Eric J Velazquez et al. Ann Thorac Surg. 2012 Feb.

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.

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Figures

Figure 1
Figure 1. Identification of Study Cohort from all Patients Undergoing Cardiac Catheterization at Duke Medical Center January 1, 1995–July 31, 2009 and Treated with Medical Therapy (MED) or Coronary Artery Bypass Grafting (CABG)
Figure 2
Figure 2
Propensity Quintiles for Selecting Medical Therapy (MED) at Duke 1995–2005. Total Patients and Mortality are Presented for Each Quintile.
Figure 3
Figure 3. Unadjusted Kaplan Meier Estimates of Time to Death in All Study Patients (Propensity Quintiles I–V)
Figure 4
Figure 4. A, Unadjusted and B, Risk-adjusted Kaplan Meier Rate Estimates of Time to Death in 395 Patients with Similar Propensity (Quintiles I–III) for Medical Therapy
Figure 4
Figure 4. A, Unadjusted and B, Risk-adjusted Kaplan Meier Rate Estimates of Time to Death in 395 Patients with Similar Propensity (Quintiles I–III) for Medical Therapy
Figure 5
Figure 5. Unadjusted Kaplan Meier Rate Estimates of Time to Death for STICH and Duke Database (DDCD) Patients
See this image and copyright information in PMC

Comment in

  • Invited commentary.
    Head SJ, Mokhles MM, Kappetein AP. Head SJ, et al. Ann Thorac Surg. 2012 Feb;93(2):530. doi: 10.1016/j.athoracsur.2011.10.075. Ann Thorac Surg. 2012. PMID: 22269721 No abstract available.

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