CABG alone was associated with the lowest mortality compared to medical treatment alone (HR 0.56; 95% CI 0.51-0.62; P<0.0001) in patients with CAD and moderate or severe ischemic mitral regurgitation.
Cohort (n=4,989)
No
Does surgical or percutaneous revascularization improve survival compared to medical therapy alone in patients with significant coronary artery disease and moderate or severe ischemic mitral regurgitation?
In patients with significant coronary artery disease and moderate or severe ischemic mitral regurgitation, CABG alone was associated with the lowest risk of death compared to medical therapy, PCI, or CABG plus mitral valve surgery.
Effect estimate: HR 0.56 (95% CI 0.51-0.62)
p-value: p=<0.0001
BACKGROUND: The optimal treatment for ischemic mitral regurgitation remains actively debated. Our objective was to evaluate the relationship between ischemic mitral regurgitation treatment strategy and survival. METHODS AND RESULTS: We retrospectively reviewed patients at our institution diagnosed with significant coronary artery disease and moderate or severe ischemic mitral regurgitation from 1990 to 2009, categorized by medical treatment alone, percutaneous coronary intervention, coronary artery bypass grafting (CABG), or CABG plus mitral valve repair or replacement. Kaplan-Meier methods and multivariable Cox proportional hazards analyses were performed to assess the relationship between treatment strategy and survival, with the use of propensity scores to account for nonrandom treatment assignment. A total of 4989 patients were included: medical treatment alone=36%, percutaneous coronary intervention=26%, CABG=33%, and CABG plus mitral valve repair or replacement=5%. Median follow-up was 5.37 years. Compared with medical treatment alone, significantly lower mortality was observed in patients treated with percutaneous coronary intervention (adjusted hazard ratio, 0.83; 95% confidence interval, 0.76-0.92; P=0.0002), CABG (adjusted hazard ratio, 0.56; 95% confidence interval, 0.51-0.62; P<0.0001), and CABG plus mitral valve repair or replacement (adjusted hazard ratio, 0.69; 95% confidence interval, 0.57-0.82; P<0.0001). There was no significant difference in these results based on mitral regurgitation severity. CONCLUSIONS: Patients with significant coronary artery disease and moderate or severe ischemic mitral regurgitation undergoing CABG alone demonstrated the lowest risk of death. CABG with or without mitral valve surgery was associated with lower mortality than either percutaneous coronary intervention or medical treatment alone.
Castleberry et al. (Fri,) conducted a cohort in Ischemic mitral regurgitation and coronary artery disease (n=4,989). CABG vs. Medical treatment alone was evaluated on Mortality (HR 0.56, 95% CI 0.51-0.62, p=<0.0001). CABG alone was associated with the lowest mortality compared to medical treatment alone (HR 0.56; 95% CI 0.51-0.62; P<0.0001) in patients with CAD and moderate or severe ischemic mitral regurgitation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: