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Long-term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) Registry

M Emond1, M B Mock, K B Davis

  • 1Coordinating Center for Collaborative Studies in Coronary Artery Surgery, University of Washington, Seattle 98105.

Circulation
|December 1, 1994
PubMed

Insights

Clinical factors like age and vessel disease significantly impact long-term survival in Coronary Artery Surgery Study (CASS) patients. Poor survival for those with three-vessel disease and low ejection fraction highlights revascularization importance.

Area of Science:

  • Cardiology
  • Clinical Outcomes Research
  • Public Health

Background:

  • The Coronary Artery Surgery Study (CASS) provided a unique dataset to analyze long-term outcomes.
  • Understanding the natural history of coronary artery disease (CAD) is crucial for patient management.
  • Medical treatment outcomes for CAD patients without prior surgery are essential historical data.

Purpose of the Study:

  • To determine the impact of clinical, angiographic, and demographic factors on long-term survival in medically treated Coronary Artery Surgery Study (CASS) patients.
  • To report revascularization rates within the CASS cohort.
  • To provide insights into the natural progression of coronary artery disease.

Main Methods:

  • Survival analysis of 23,467 Coronary Artery Surgery Study (CASS) patients initially treated medically.
  • Follow-up duration ranged from 0 to 17 years (median 12 years), with vital status known for 95.8% of patients.
  • Statistical methods included log-rank tests, Kaplan-Meier survival curves, and Cox proportional-hazards regression.

Main Results:

  • Age, number of diseased vessels, congestive heart failure score, and ejection fraction were key predictors of survival.
  • Twelve-year survival rates varied significantly: 88% for zero-vessel disease to 40% for three-vessel disease.
  • Survival decreased markedly with lower ejection fractions, with 12-year survival as low as 21% for ejection fractions 0-34%.

Conclusions:

  • The study elucidates the natural history of coronary artery disease in a large, medically treated cohort.
  • Findings underscore the critical prognostic importance of the number of diseased vessels and left ventricular function (ejection fraction).
  • The persistently poor survival in patients with three-vessel disease and low ejection fraction reinforces the consideration for revascularization in such cases.
Abstract

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