Coronary-artery bypass surgery in patients with left ventricular dysfunction

January 01, 0001

Coronary-artery bypass surgery in patients with left ventricular dysfunction

These investigators from multiple countries conducted a randomized controlled trial to compare coronary-artery bypass grafting (CABG) with medical management in the treatment of patients with coronary artery disease and heart failure between July 2002 and May 2007. Participants were 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG. The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.

They found: "The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86;not significant). A total of 201 patients (33%) in the medical- therapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74). By the end of the follow-up period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG."

The authors concluded: "In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes."

CABG is marginally if any better than medical management for patients with LV dysfunction.


For the full abstract, click here.

N Engl J Med 364:1607-1616, 28 April 2011
© 2011 to the Massachusetts Medical Society
Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction. Eric J. Velazquez, Kerry L. Lee, Marek A. Deja, et al. Correspondence to Dr. Velazquez: [email protected]

Category: K. Circulatory. Keywords: coronary artery bypass grafting, CABG, left ventricular dysfunction, medical management, mortality, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 10 May 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.