Related Experiment Videos
Two- to eight-year survival rates in patients who refused coronary artery bypass grafting
W Hueb1, G Bellotti, J A Ramires
1Division of Clinical Cardiology, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
Insights
Optimal medical therapy for coronary artery disease (CAD) patients refusing surgery shows good survival and symptom relief. However, coronary atherosclerosis progression still occurs in some individuals.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Coronary artery disease (CAD) management often involves revascularization, but some patients refuse bypass grafting.
- Long-term outcomes for medically treated CAD patients with preserved ejection fraction are crucial.
Purpose of the Study:
- To evaluate the long-term outcomes of medically treated coronary artery disease (CAD) patients who declined bypass grafting.
- To assess survival rates, symptom incidence, and disease progression in this selected patient group.
Main Methods:
- Prospective follow-up of 150 patients with CAD (1-vessel, multiple-vessel, left main equivalent) over 2-8 years.
- Medical treatment included beta-blockers, calcium channel blockers, nitrates, dipyridamole, and aspirin.
- Repeat hemodynamic studies were performed in a subset of patients to assess disease progression.
Main Results:
- Low annual mortality rates: 0% for 1-2 vessel CAD, 1.3% for more severe disease.
- Significant reduction in stable and unstable angina incidence.
- 61% showed stenosis progression or new obstructions; 12% developed new occlusions.
- Nonfatal myocardial infarction incidence was 8%; ejection fraction remained stable.
Conclusions:
- Medical management in selected advanced CAD patients with preserved ventricular function offers good long-term survival and symptom control.
- Despite effective treatment, coronary atherosclerosis progression is observed in a significant proportion of patients.
- This approach highlights the viability of medical therapy as an alternative to surgery in specific CAD cases.
Abstract:
One hundred and fifty patients with coronary artery disease (CAD) who refused bypass grafting were followed prospectively from 2 to 8 years. Mean age was 57 +/- 8 (standard deviation) years. Ejection fraction averaged 70 +/- 14%. Eight percent of patients had 1-vessel CAD and 92% had multiple-vessel CAD. Medical treatment included propranolol, nifedipine, isosorbide dinitrate, dipyridamole and aspirin. Annual mortality was 0% for 1- and 2-vessel CAD and 1.3% for left main equivalent disease, 3-vessel and left main CAD. Treatment significantly reduced the incidence of stable and unstable angina. Fifty-two patients (34%) had a second hemodynamic study 4.2 +/- 1.3 years after initial evaluation. Stenosis progression or new significant obstructions (greater than or equal to 70%) in previously normal coronary arteries occurred in 61% of 123 arteries studied, whereas new occlusions were observed in 12% of the arteries. Nonfatal acute myocardial infarction incidence was 8%. No significant changes occurred in ejection fraction. In conclusion, proper medical treatment in selected patients with advanced CAD but preserved ventricular function is associated with good long-term survival and remission of symptoms, although progression of coronary atherosclerosis does occur in some patients.