Improvement in long-term prognosis by coronary bypass surgery in patients with 3-vessel coronary disease--a matched...

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Clinical Medicine

Background:

• Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
• Optimal treatment strategies for patients with significant three-vessel disease are continually being evaluated.
• Matching patient characteristics is crucial for comparing medical versus surgical interventions.

Purpose of the Study:

• To compare long-term survival and ischemic event rates between medically and surgically treated patients with three-vessel coronary artery disease.
• To evaluate the efficacy of surgical revascularization versus medical management in a matched cohort.

Main Methods:

• A comparative study of 61 medically treated and 78 surgically treated patients at a Japanese community hospital.
• Patients were matched for significant three-vessel disease, ejection fraction >40%, bypassable left anterior descending artery, sex, and age.
• Survival and ischemic event rates (non-fatal myocardial infarction, primary cardiac death) were analyzed using Cox-Mantel analysis.

Main Results:

• Surgically treated patients demonstrated significantly better 5- and 9-year survival rates (93% and 85%) compared to medically treated patients (74% and 55%; p < 0.01).
• Rates of absence of ischemic events at 5 and 9 years were superior in the surgical group (92% and 87%) versus the medical group (66% and 52%; p < 0.001).
• Perioperative mortality in the surgical group was low (5 deaths), with few late cardiac events, while the medical group experienced higher cardiac mortality and non-fatal infarctions.

Conclusions:

• Surgical treatment, utilizing saphenous vein grafts, offers a survival advantage for patients with three-vessel coronary artery disease compared to medical management.
• The study suggests that surgical intervention is associated with a reduced incidence of major adverse cardiac events in this patient population.
• Despite being a non-randomized study, the findings indicate a significant benefit of surgical treatment for selected patients with complex coronary artery disease.