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LONG-TERM BENEFITS OF SURGERY IN PATIENTS WITH LEFT MAIN CORONARY DISEASE.

Most studies that measure the relative benefits of surgery versus medical therapy for coronary artery disease compare outcomes after a few years at most. These investigators followed nearly 25,000 patients who underwent coronary angiography at 15 hospitals in North America between 1974 and 1979 and present the long-term outcomes of patients with the most extensive coronary disease. The first report describes the outcome of the 1484 patients with left main coronary disease. The median survival among the 1153 patients who underwent surgical therapy was 13.3 years versus only 6.6 years for patients treated with medication. However, the benefit of surgery could not be demonstrated in some patient subsets, including those with mild disease (stenosis of 50 to 59 percent), normal left ventricular function, without severe right coronary stenosis, or with good left ventricular function even in the presence of severe right coronary stenosis. The second report focused on 912 patients with "left main equivalent disease" (combined stenosis of 70 percent in the proximal left anterior descending and proximal left circumflex coronary artery). Median survival was 13.1 years and 6.2 years for the surgical and medical groups, respectively. Again, surgery was not associated with increased survival among those with normal left ventricular function, even in the presence of significant right coronary disease. In the two studies, 25 percent of medically treated patients eventually underwent bypass graft surgery. Comment: These two studies provide valuable long-term data about survival with severe coronary disease and demonstrate that the benefit of surgery appears to be limited to patients with the worst prognosis -- those with abnormal left ventricular function.

— TH Lee

Published in Journal Watch General Medicine May 12, 1995

Citation(s):

Caracciolo EA, et al. Long-term CASS experience. Circulation 1995 May 91 2335-2344.

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• Medline abstract (Free)

Caracciolo EA, et al. Comparison of surgical and medical group survival in patients with left main equivalent coronary artery disease. Circulation 1995 May 91 2325-2334.

• Original article (Subscription may be required)
• Medline abstract (Free)