Circulation, Vol 82, 1629-1646, Copyright © 1990 by American Heart Association
EL Alderman, MG Bourassa, LS Cohen, KB Davis, GG Kaiser, T Killip, MB Mock, M Pettinger and TL Robertson
The Coronary Artery Surgery Study (CASS) randomized 780 patients to an
initial strategy of coronary surgery or medical therapy. Of medically
randomized patients, 6% had surgery within 6 months and a total of 40% had
surgery by 10 years. At 10 years, there was no difference in cumulative
survival (medical, 79% vs. surgical, 82%; NS) and no difference in
percentage free of death and nonfatal myocardial infarction (medical, 69%
vs. surgical, 66%; NS). Patients with an ejection fraction of less than
0.50 exhibited a better survival with initial surgery treatment (medical,
61% vs. surgical, 79%; p = 0.01). Conversely, patients with an ejection
fraction greater than or equal to 0.50 exhibited a higher proportion free
of death and myocardial infarction with initial medical therapy (medical,
75% vs. surgical, 68%; p = 0.04) although long-term survival remained
unaffected (medical, 84% vs. surgical, 83%; p = 0.75). There were no
significant differences either in survival and freedom from nonfatal
myocardial infarction, whether stratified on presence of heart failure,
age, hypertension, or number of vessels diseased. Thus, 10-year follow-up
results confirm earlier reports from CASS that patients with left
ventricular dysfunction exhibit long-term benefit from an initial strategy
of surgical treatment. Patients with mild stable angina and normal left
ventricular function randomized to initial medical treatment (with an
option for later surgery if symptoms progress) have survival equivalent to
those patients randomized to initial surgery.
ARTICLES
Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study
Stanford University, California.
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