Journal of Cardio-Thoracic Medicine

Journal of Cardio-Thoracic Medicine

Comparison of Treatment Outcomes in Off-pump Coronary Artery Bypass Graft and Medical Therapy in Patients with Triple-vessel Coronary Artery Disease and Severe Ventricular Dysfunction

Document Type : Original Article

Authors
Feridoun Sabzi 1
Hossein Karim 2
Shahrokh Chaghazardi 2
Atefeh Asadmobini 3
1 Cardiac Surgean, Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
2 Cardiologist, Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
3 MSc of Cardiac Physiology, Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
10.22038/jctm.2016.6959
Abstract
Introduction: Heart failure is a major hazard for public health. Despite recent advance in medical therapy, there is not enough information on the outcome of off-pump coronary artery bypass (OPCAB) and medical therapy on the patients with severe ventricular dysfunction and triple-vessel (CAD). This study aimed to compare treatment outcomes and mortality rate in patients undergoing off-pump coronary artery bypass (OPCAB) surgery and medical therapy who presented with severe ventricular dysfunction and triple-vessel coronary artery disease (CAD).
Materials and Methods: This retrospective cohort study was conducted on patients with severe ventricular dysfunction and triple-vessel CAD during 2010-2011 in the Imam Ali Hospital of Kermanshah University of Medical Science. Patients were divided into two groups of medical therapy (group one) and OPCAB (group two). Follow-up data were collected after 30 months. Survival estimation was performed using Kaplan-Meier survival analysis and Cox regression model.
Results: Of the 276 enrolled patients, 139(50.4%) underwent group one and 137(49.6%) group two. Study groups were homogenous in baseline characteristics, with the exception of hyperlipidemia (P=0.005). A significant difference was observed in cardiac mortality rates between the study groups (hazard ratio: 0.260; 95% confidence interval: 0.105-0.644; P=0.004). However, no significant difference was observed between the groups regarding the frequency of admission due to decompensate heart failure (P=0.17). In addition, the rate of admission due to acute coronary syndrome (ACS) in the first group was higher than the second group, significantly (P=0.001). Level of ejection fraction (EF) had a significant increase after coronary artery bypass graft (CABG) (28.50) compared to the preoperative stage (27.59) (P=0.042). However, no significant increase in the level of EF was observed in the first group before and after medical therapy (27.28 and 27.20, respectively) (P=0.83).
Conclusion: According to the results of this study, the mortality rate associated with OPCAB was lower compared to medical therapy, ACS and EF enhancement in patients with triple-vessel CAD and severe ventricular dysfunction.
Keywords
Coronary Artery Disease
Medical Therapy
Off-Pump Coronary Artery Bypass Graft
  1. Cheng S, Vasan RS. Advances in the epidemiology of heart failure and left ventricular remodeling. Circulation. 2011; 124:e516-9.
  2. Lam CS, Donal E, Kraigher‐Krainer E, Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011; 13:18-28.
  3. Loehr LR, Rosamond WD, Chang PP, Folsom AR, Chambless LE. Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study). Am J Cardiol. 2008; 22:1016-22.
  4. Klenk J, Rapp K, Büchele G, Keil U, Weiland SK. Increasing life expectancy in Germany: quantitative contributions from changes in age-and disease-specific mortality. Eur J Public Health. 2007; 17:587-92.
  5. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, et al. Heart disease and stroke statistics--2009 update a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009; 119:e21-181.
  6. Morrison DA, Sacks J. Balancing benefit against risk in the choice of therapy for coronary artery disease. Lesson from prospective, randomized, clinical trials of percutaneous coronary intervention and coronary artery bypass graft surgery. Minerva Cardioangiol. 2003; 51:585-97.
  7. Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2006; 48:e1-148.
  8. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 2003; 41:159-68.
  9. Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation. 2004; 110:e340-437.
  10.  Blumenthal RS, Cohn G, Schulman SP. Medical therapy versus coronary angioplasty in stable coronary artery disease: a critical review of the literature. J Am Coll Cardiol. 2000; 36:668-73.
  11.  Caracciolo EA, Davis KB, Sopko G, Kaiser GC, Corley SD, Schaff H, et al. Comparison of surgical and medical group survival in patients with left main coronary artery disease. Long-term CASS experience. Circulation. 1995; 91:2325-34.
  12.  Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, et al. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation. 1983; 68:785-95.
  13.  Passamani E, Davis KB, Gillespie MJ, Killip T. A randomized trial of coronary artery bypass surgery. Survival of patients with a low ejection fraction. N Engl J Med. 1985; 312:1665-71.
  14. Muhlbaier LH, Pryor DB, Rankin JS, Smith LR, Mark DB, Jones RH, et al. Observational comparison of event-free survival with medical and surgical therapy in patients with coronary artery disease. 20 years of follow-up. Circulation. 1992; 86(5 Suppl):II198-204.
  15.  Bonow RO, Maurer G, Lee KL, Holly TA, Binkley PF, Desvigne-Nickens P, et al. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med. 2011; 364:1617-25.
  16.  Supino PG, Borer JS, Herrold EM, Hochreiter C. Prognostication in 3-vessel coronary artery disease based on left ventricular ejection fraction during exercise: influence of coronary artery bypass grafting. Circulation. 1999; 100:924-32.
  17.  Lechat P, Jaillon P, Fontaine M, Chanton E, Mesenge C, Gagey S, et al. A randomized trial of beta-blockade in heart-failure. The Cardiac-Insufficiency Bisoprolol Study (CIBIS). CIBIS Investigators and Committees. Circulation. 1994; 90:1765-73.
  18.  Packer M, O'Connor CM, Ghali JK, Pressler ML, Carson PE, Belkin RN, et al. Effect of amlodipine on morbidity and mortality in severe chronic heart failure. Prospective Randomized Amlodipine Survival Evaluation Study Group. N Engl J Med. 1996; 335:1107-14.
  19.  O’Connor CM, Velazquez EJ, Gardner LH, Smith PK, Newman MF, Landolfo KP, et al. Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank). Am J Cardiol. 2002; 90:101-7.
  20.  Velazquez EJ, Williams JB, Yow E, Shaw LK, Lee KL, Phillips HR, et al. Long-term survival of patients with ischemic cardiomyopathy treated by coronary artery bypass grafting versus medical therapy. Ann Thorac Surg. 2012; 93:523-30.
  21.  Elefteriades JA, Tolis G Jr, Levi E, Mills LK, Zaret BL. Coronary artery bypass grafting in severe left ventricular dysfunction: excellent survival with improved ejection fraction and functional state. J Am Coll Cardiol. 1993; 22:1411-7.
  22.  Karimi A, Marzban M, Movahedi N, Salehiomran A, Sadeghian S, Goodarzynejad H. Traditional cardiac risk factors profile in Iranian patients undergoing coronary artery bypass surgery. Acta Cardiol. 2009; 64:371-7.
  23.  Soleimani A, Abbasi A, Kazzazi EH, Hosseini K, Salirifar M, Darabian S, et al. Prevalence of left main coronary artery disease among patients with ischemic heart disease: insights from the Tehran Angiography Registry. Minerva Cardioangiol. 2009; 57:175-83.
  24.  Hochberg MS, Parsonnet V, Gielchinsky I, Hussain SM. Coronary artery bypass grafting in patients with ejection fractions below forty percent. Early and late results in 466 patients. J Thorac Cardiovasc Surg. 1983; 86:519-27.
  25.  Nardi P, Pellegrino A, Scafuri A, Colella D, Bassano C, Polisca P, et al. Long-term outcome of coronary artery bypass grafting in patients with left ventricular dysfunction. Ann Thorac Surg. 2009; 87:1401-7.
Journal of Cardio-Thoracic Medicine
Volume 4, Issue 2
Spring 2016
Pages 450-455