Document Detail


Impaired left ventricular function, one- or two-vessel coronary artery disease, and severe ischemia: outcome with medical therapy versus revascularization.
MedLine Citation:
PMID:  8015324     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether patients with impaired left ventricular function and one- or two-vessel coronary artery disease who manifest severe ischemia during exercise radionuclide angiography have a lower rate of subsequent cardiac events when initial management is revascularization rather than medical therapy.
DESIGN: During a median follow-up of 100 months, we compared the outcome between 37 patients who underwent a revascularization procedure and 22 who received medical therapy at the Mayo Clinic between September 1980 and December 1985.
MATERIAL AND METHODS: The revascularization therapy consisted of coronary artery bypass grafting in 31 patients and coronary angioplasty in 6. Overall survival and survival free of initial cardiac events were compared statistically for the medically and surgically treated patients.
RESULTS: Eleven deaths occurred in the patients who received medical therapy and 9 in the revascularization group. Five-year overall survival was 58% in the medically treated patients versus 84% in the revascularization group. A significant association was noted between type of treatment and overall survival (adjusted chi 2 = 6.20; P = 0.013). Twenty patients had initial cardiac events--7 in the medically treated group (3 cardiac deaths and 4 nonfatal myocardial infarctions) and 13 in the revascularization group (3 cardiac deaths, 3 out-of-hospital cardiac arrests, and 7 nonfatal myocardial infarctions). Survival free of cardiac events at 5 years was 72% in the medically treated patients and 66% in those who underwent revascularization. No association was detected between type of treatment and survival free of cardiac events.
CONCLUSION: These nonrandomized data suggest that overall survival for patients with one- or two-vessel coronary artery disease, impaired left ventricular function, and severe exercise-induced ischemia may be improved by revascularization, but the subsequent cardiac event rates are not.
Authors:
T D Miller; T F Christian; C P Taliercio; A R Zinsmeister; T A Orszulak; H V Schaff; R J Gibbons
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  69     ISSN:  0025-6196     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  1994 Jul 
Date Detail:
Created Date:  1994-07-27     Completed Date:  1994-07-27     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  626-31     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary
Coronary Artery Bypass
Coronary Disease / mortality,  pathology,  physiopathology,  therapy*
Coronary Vessels / pathology*
Exercise Test
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Revascularization*
Postoperative Complications
Survival Rate
Treatment Outcome
Ventricular Function, Left*
Comments/Corrections
Comment In:
Mayo Clin Proc. 1995 Jan;70(1):101-3   [PMID:  7808044 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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