Document Detail


Revascularization in severe ventricular dysfunction (15% < OR = LVEF < OR = 30%): a comparison of bypass grafting and percutaneous intervention.
MedLine Citation:
PMID:  12643399     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We sought to determine the optimal approach to revascularization of patients with severe left ventricular (LV) dysfunction. METHODS: We conducted a single-center observational study of 117 consecutive patients who had severe LV dysfunction (15% < OR = LV ejection fraction < OR = 30%) and underwent either coronary artery bypass grafting (CABG, n = 69) or percutaneous revascularization (n = 48) between 1992 and 1997. RESULTS: The CABG group was younger (62 versus 67 years, p = 0.026), and fewer previous bypasses (7% versus 40%, p < 0.0001) and fewer prior percutaneous revascularizations (16% versus 42%, p = 0.0019) were noted. More vessels were revascularized (3 +/- 0.8 versus 1.5 +/- 0.7, p < 0.0001), and revascularization was more complete by CABG (84% versus 48%, p < 0.0001). Morbidity and mortality at 30 days were similar, and there was no significant difference in 3-year survival (73% versus 67%), although 3-year cardiac event-free survival (52% versus 25%, p = 0.0011) and 3-year target vessel revascularization-free survival (71% versus 41%, p < 0.0001) were significantly better in the CABG group, and LV ejection fraction was significantly improved after CABG. In the subgroup of patients 65 years of age or older and those without proximal left anterior descending coronary artery lesions, significant benefit of CABG in cardiac event-free and target vessel revascularization-free survival disappeared. CONCLUSIONS: We found that in clinically selected patients with severe ventricular dysfunction, CABG compared with percutaneous revascularization achieves more complete revascularization, improved LV function, fewer cardiac events, and fewer target vessel revascularizations, but does not affect mid-term survival. A prospective controlled trial with defined criteria for treatment assignment is warranted to confirm our results regarding the two revascularization strategies in patients with severe LV dysfunction.
Authors:
Koichi Toda; Karen Mackenzie; Mandeep R Mehra; Charles J DiCorte; James E Davis; P Michael McFadden; John L Ochsner; Christopher White; Clifford H Van Meter
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  74     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2002 Dec 
Date Detail:
Created Date:  2003-03-19     Completed Date:  2003-04-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2082-7; discussion 2087     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana 07121, USA.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Artery Bypass*
Female
Humans
Male
Middle Aged
Myocardial Revascularization / methods*
Retrospective Studies
Stroke Volume
Survival Rate
Ventricular Dysfunction, Left / mortality,  surgery*

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


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