Circulation, Vol 82, 1647-1658, Copyright © 1990 by American Heart Association
WJ Rogers, CJ Coggin, BJ Gersh, LD Fisher, WO Myers, A Oberman and LT Sheffield
Quality of life indexes were assessed in 780 patients 10 years after
randomization to medical therapy (n = 390) or coronary artery bypass graft
surgery (n = 390) in the Coronary Artery Surgery Study. At 10 years,
mortality was 21.8% in the medical group and 19.2% in the surgical group (p
= NS), and 144 (37%) of the medical group had undergone surgery because of
increasing chest pain. At study entry, 22% of medical and surgical patients
were angina free; at 1 and 5 years after entry, the frequency of
asymptomatic patients was 66% and 63% in the surgical group and 30% and 38%
in the medical group. However, by 10 years after entry, the proportion of
patients free of angina had fallen to 47% in the surgical group and to 42%
in the medical group. Activity limitation and use of beta-blockers and
long-acting nitrates were less in the surgical than the medical group at 1
and 5 years after entry but little different from the medical group at 10
years after entry. Throughout follow-up, recreational status, employment
status, frequency of heart failure, use of other medications, and
hospitalization frequency were similar between the two groups. Thus,
indexes of quality of life such as angina relief, increased activity, and
reduction in use of antianginal medications initially appear superior in
patients with stable manifestations of ischemic heart disease assigned to
surgery, but by 10 years after entry, these advantages are much less
apparent. Although the observed similarities of the medically and
surgically assigned groups at 10 years reflect return of symptoms in the
surgical group to some extent, a more important explanation is the
performance of late surgery in a large proportion of the medically assigned
patients, rendering them asymptomatic.
ARTICLES
Ten-year follow-up of quality of life in patients randomized to receive medical therapy or coronary artery bypass graft surgery. The Coronary Artery Surgery Study (CASS)
CASS Coordinating Center, University of Washington, Seattle 98105.
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