Circulation, Vol 73, 1254-1263, Copyright © 1986 by American Heart Association
DR Holmes Jr, KB Davis, MB Mock, LD Fisher, BJ Gersh, T Killip 3d and M Pettinger
The effect of medical and surgical treatment on subsequent sudden cardiac
death was assessed in 13,476 patients in the Coronary Artery Surgery Study
registry who had significant coronary artery disease, operable vessels, and
no significant valvular disease. (Patients were assigned to medical or
surgical therapy on the basis of clinical judgment and not according to a
randomization scheme; therefore, biases associated with unknown variables
could not be evaluated.) Sudden cardiac death occurred in 452 patients
(3.4%) during a mean follow-up of 4.6 years. Five year survival free of
sudden death for medically treated patients was 94 +/- 0.3%, and that for
surgically treated patients was 98 +/- 0.2% (p less than .0001). Twelve
baseline clinical, electrocardiographic, and angiographic variables were
significantly different between patients alive at the last follow-up and
those suffering sudden death. Data on these variables were available for
11,508 patients. Sudden death occurred in 257 (4.9%) of 5258 medically
treated and 101 (1.6%) of 6250 surgically treated patients. In a high- risk
patient subset with three-vessel disease and history of congestive heart
failure, 91% of surgically treated patients had not suffered sudden death
compared with 69% of medically treated patients. After Cox survival
analysis was used to correct for baseline variables, surgical treatment had
an independent effect on sudden death (p less than .0001). This reduction
was most pronounced in high-risk patients.
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The effect of medical and surgical treatment on subsequent sudden cardiac death in patients with coronary artery disease: a report from the Coronary Artery Surgery Study
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