What question did this study set out to answer?

To evaluate long-term survival outcomes over more than 16 years of follow-up comparing surgical and medical management in patients with left main equivalent coronary artery disease.

May 1, 1995Circulation

Comparison of Surgical and Medical Group Survival in Patients With Left Main Equivalent Coronary Artery Disease

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Left main equivalent (LMEQ) coronary artery disease (n=912). Intervention: Coronary artery bypass graft (CABG) surgery vs. Medical therapy. Primary outcome: 15-year cumulative survival (Median survival difference 6.9 years, p=<.0001).

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Key result

CABG surgery was associated with higher 15-year cumulative survival compared to medical therapy (44% vs 31%) and prolonged median survival by 6.9 years (P<0.0001) in patients with LMEQ disease.

Why the study?

Does CABG surgery improve long-term survival compared to medical therapy in patients with left main equivalent coronary artery disease?

Key Points

To evaluate long-term survival outcomes over more than 16 years of follow-up comparing surgical and medical management in patients with left main equivalent coronary artery disease.
Analysis of 912 patients with left main equivalent disease (stenoses ≥70% in proximal left anterior descending and proximal circumflex arteries) from the Coronary Artery Surgery Study (CASS) Registry.
Patients initially received either coronary artery bypass graft surgery (n=630) or nonsurgical medical therapy (n=282), with follow-up extending beyond 16 years across clinical and angiographic subgroups.
Fifteen-year cumulative survival was 44% in the surgical group versus 31% in the medical group, with a median survival of 13.1 years (95% CI, 12.7 to 14.1) versus 6.2 years (95% CI, 4.8 to 7.9; difference 6.9 years, P < 0.0001).
In patients with normal left ventricular systolic function, 15-year cumulative survival was 63% with surgery versus 54% with medical therapy, and median survival exceeded 15 years in both groups (P = NS); similar non-significant differences occurred despite coexisting right coronary artery stenosis ≥70% (63% vs 53%, median >15 years, P = NS).
Among trial-eligible or randomized patients with ejection fraction ≥50%, 15-year survival did not differ significantly between surgery and medical therapy (randomized: 71% vs 67%; randomizable: 62% vs 92%).

Study Design

Type

Cohort (n=912)

Structured PICO

Does CABG surgery improve long-term survival compared to medical therapy in patients with left main equivalent coronary artery disease?

Population

912 patients with left main equivalent coronary artery disease from the CASS Registry, initially treated with surgical or medical therapy, followed for over 16 years.

Exposure

Surgical therapy (coronary artery bypass graft [CABG] surgery)

Comparator

Nonsurgical (medical) therapy

Outcome

15-year cumulative survival and median survivalhard clinical

Main Result

Effect estimate: Median survival difference 6.9 years

Absolute Event Rate: 44% vs 31%

p-value: p=<.0001

CABG surgery significantly prolongs long-term survival compared to medical therapy in most patients with left main equivalent disease, but does not appear to prolong survival in those with normal left ventricular systolic function.

Discussion

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Implication

May support CABG evaluation in LMEQ disease; extends observational data but leaves open need for randomized confirmation.

Cite This Study

Caracciolo et al. (1995) conducted a cohort in Left main equivalent (LMEQ) coronary artery disease (n=912). Coronary artery bypass graft (CABG) surgery vs. Medical therapy was evaluated on 15-year cumulative survival (Median survival difference 6.9 years, p=<.0001). CABG surgery was associated with higher 15-year cumulative survival compared to medical therapy (44% vs 31%) and prolonged median survival by 6.9 years (P<0.0001) in patients with LMEQ disease.

synapsesocial.com/papers/6a93e37da0db6e712b872300 https://doi.org/10.1161/01.cir.91.9.2335

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Comparison of Surgical and Medical Group Survival in Patients With Left Main Equivalent Coronary Artery Disease

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Comparison of Surgical and Medical Group Survival in Patients With Left Main Equivalent Coronary Artery Disease

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Also Consider