Surgical versus medical treatment of coronary artery disease

Abstract

To ascertain whether surgical therapy increases the life expectancy of patients with coronary artery occlusive disease, 9,061 consecutive patients undergoing aortocoronary bypass from July 1968 through June 1977 were reviewed and followed for up to nine years.

Among all patients undergoing aortocoronary bypass without concomitant procedures, early mortality was 3.5 per cent (9.1 per cent in 1970 and 1.7 per cent during 1977). Late mortality was significantly lower in those patients receiving four grafts or more (0.7 per cent) and triple grafts (2.2 per cent) compared with patients undergoing either double grafts (4.4 per cent) or single grafts (3.5 per cent). This emphasizes the importance of complete revascularization. Nine year follow-up determined that 91.0 per cent of surviving patients were asymptomatic or significantly improved.

Actuarial (Cutler) curves including early and late mortality demonstrated that 92 per cent of patients were alive at three years and 80 per cent at nine years after aortocoronary bypass. These results compare favorably with those of the recently published randomized Veterans' Administration Cooperative Study, which reported that at three years 87 per cent of medically treated patients were alive. Their follow-up extended only three years, but if their actuarial curves are projected to nine years, only 61 per cent of medically treated patients will be anticipated to be alive, compared to 80 per cent of patients treated surgically in the present series. These data suggest that surgical treatment of patients with coronary artery occlusive disease significantly improves long-term survival.