The evolution of medical and surgical therapy for coronary artery disease. A 15-year perspective.

Califf RM, Harrell FE, Lee KL, Rankin JS, Hlatky MA, Mark DB, Jones RH, Muhlbaier LH, Oldham HN, Pryor DB
JAMA. 1989 261 (14): 2077-86

PMID: 2784512

To elucidate the factors associated with improved survival following coronary artery bypass surgery, we studied 5809 patients receiving medical or surgical therapy for coronary artery disease. Three factors were associated with a significant surgical survival benefit: more severe coronary disease, a worse prognosis with medical therapy, and a more recent operative date. Patients with more extensive coronary obstruction had the greatest improvement in survival. Patients with a poor prognosis because of factors such as older age, severe angina, or left ventricular dysfunction had a reduction in risk that was proportionate to their overall risk on medical therapy. Survival with surgery progressively improved over the study period and by 1984 surgery was significantly better than medical therapy for most patient subgroups. Thus, contemporary coronary revascularization is associated with improved longevity in many patients with ischemic heart disease, especially in those with adverse prognostic indicators.

MeSH Terms (13)

Age Factors Angina, Unstable Cardiac Catheterization Coronary Artery Bypass Coronary Disease Female Humans Male Middle Aged Prognosis Prospective Studies Risk Stroke Volume

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