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Survival following coronary artery bypass grafting in patients with severe angina pectoris (CASS). An observational
Insights
Coronary artery bypass grafting improves survival for patients with severe angina and triple vessel disease. Surgical treatment offers better long-term outcomes compared to nonoperative management in high-risk ischemic heart disease patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Prognosis in ischemic heart disease is influenced by angina severity and left ventricular function.
- Treatment decisions for coronary artery disease require consideration of both clinical and anatomical factors.
Purpose of the Study:
- To evaluate the impact of angina severity and treatment strategy on survival in patients within the Coronary Artery Surgery Study registry.
- To compare the long-term survival rates of surgically versus nonoperatively treated patients with varying degrees of coronary artery disease and angina.
Main Methods:
- Observational study of 4,209 patients from the Coronary Artery Surgery Study registry.
- Inclusion criteria mirrored the randomized trial, excluding treatment selection criteria and focusing on angina class.
- Analysis of 5-year survival rates based on angina classification, left ventricular function, number of diseased vessels, and treatment modality.
Main Results:
- Patients with Class I/II angina and normal left ventricular function had survival rates >=93% regardless of treatment or vessel involvement.
- Surgically treated patients with Class III/IV angina and normal LV function had survival rates >=92%, similar across vessel involvement.
- Nonoperatively treated patients with Class III/IV angina and normal LV function had poorer survival, especially with three-vessel disease (74%).
- In patients with abnormal LV function, three-vessel disease, and severe angina, operative (82%) vs. nonoperative (52%) treatment significantly improved 5-year survival.
Conclusions:
- Clinical factors like angina severity are crucial for predicting prognosis in ischemic heart disease.
- Coronary artery bypass grafting significantly enhances late survival in patients with triple vessel disease and severe angina pectoris.
- Treatment strategy plays a vital role in determining outcomes for patients with advanced coronary artery disease and significant symptoms.
Abstract:
This observational study evaluates the effects of the severity of angina pectoris and the treatment method upon the survival of 4,209 patients in the Coronary Artery Surgery Study registry. In this nonrandomized study, these patients met the criteria used in the Coronary Artery Surgery Study randomized trial, except for the degree of angina pectoris and the method of selection of treatment. The 5 year survival rate was greater than or equal to 93% in patients with Class I and II angina pectoris and normal left ventricular function, regardless of the number of involved vessels or treatment received. Late survival of surgically treated patients with Class III and IV angina pectoris and normal left ventricular function was similar, regardless of the number of vessels involved (greater than or equal to 92% at 5 years). Nonoperatively treated patients with Class III and IV angina pectoris and normal left ventricular function had poorer 5 year survival rates, lowest (74%) in patients with three vessel disease (p less than 0.0001). This difference was also observed in patients with abnormal left ventricular function, three vessel disease, and Class III and IV angina pectoris; the 5 year survival rates were 82% for the operative group and 52% for the nonoperative group (p less than 0.0001). These data confirm the importance of clinical as well as anatomic factors in determining the prognosis of patients with ischemic heart disease and indicate that coronary artery bypass grafting can improve late survival in patients with triple vessel disease and severe angina pectoris.