IMPAIRED LEFT-VENTRICULAR FUNCTION, ONE-VESSEL OR 2-VESSEL CORONARY-ARTERY DISEASE, AND SEVERE ISCHEMIA - OUTCOME WITH MEDICAL THERAPY VERSUS REVASCULARIZATION

Objective: To determine whether patients with impaired left ventricula r function and one- or two-vessel coronary artery disease who manifest severe ischemia during exercise radionuclide angiography have a lower rate of subsequent cardiac events when initial management is revascul arization rather than medical therapy. Design: During a median follow- up of 100 months, we compared the outcome between 37 patients who unde rwent a revascularization procedure and 22 who received medical therap y at the Mayo Clinic between September 1980 and December 1985. Materia l and Methods: The revascularization therapy consisted of coronary art ery bypass grafting in 31 patients and coronary angioplasty in 6. Over all survival and survival free of initial cardiac events were compared statistically for the medically and surgically treated patients. Resu lts: Eleven deaths occurred in the patients who received medical thera py and 9 in the revascularization group. Five-year overall survival wa s 58 % in the medically treated patients versus 84 % in the revascular ization group. A significant association was noted between type of tre atment and overall survival (adjusted chi(2) = 6.20; P = 0.013), Twent y patients had initial cardiac events-7 in the medically treated group (3 cardiac deaths and 4 nonfatal myocardial infarctions) and 13 in th e revascularization group (3 cardiac deaths, 3 out-of-hospital cardiac arrests, and 7 nonfatal myocardial infarctions). Survival free of car diac events at 5 years was 72 % in the medically treated patients and 66 % in those who underwent revascularization. No association was dete cted between type of treatment and survival free of cardiac events. Co nclusion: These nonrandomized data suggest that overall survival for p atients with one- or two-vessel coronary artery disease, impaired left ventricular function, and severe exercise-induced ischemia may be imp roved by revascularization, but the subsequent cardiac event rates are not.