Circulation, Vol 66, 14-22, Copyright © 1982 by American Heart Association
T Takaro, P Peduzzi, KM Detre, HN Hultgren, ML Murphy, J van der Bel-Kahn, J Thomsen and WR Meadows
This report presents the 42-month survival experience of 91 patients with a
significant lesion of the left main coronary artery in the Veterans
Administration Cooperative Study of Coronary Bypass Surgery. Survival in
surgical patients was significantly better than that in the medical group
(p = 0.016), even after adjustments were made for two important differences
in baseline characteristics--duration of angina and high risk by
angiographic criteria--between the two groups (p = 0.019). Subgroups based
on severity of left main stenosis and on left ventricular (LV) function
showed significant trends in favor of surgery in patients with more than
75% left main stenosis and in those with abnormal LV function. A similar
but nonsignificant trend was seen in the two subgroups with 50-75% stenosis
or with normal LV function. The surgical benefits were not significantly
different between the categories of the subgroups defined separately by
stenosis and LV function. Low-, middle- and high-risk subgroups based on
four noninvasive clinical predictors also showed significantly improved
survival with surgery in the high-risk group. The low-risk groups showed a
slight, nonsignificant disadvantage with surgical treatment. These data
support the view that patients with left main disease are not a homogeneous
group. High- and low-risk subgroups with different outcomes and responses
to treatment can be delineated by angiographic or clinical criteria. For
most patients with left main disease, coronary artery bypass grafting
offers improved longevity.
ARTICLES
Survival in subgroups of patients with left main coronary artery disease. Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease
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