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Ann Thorac Surg 2003;75:S2-S5
© 2003 The Society of Thoracic Surgeons

Supplement

The role of coronary revascularization in the treatment of ischemic cardiomyopathy

Bruce W. Lytle, MDa*

a Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA

* Address reprint requests to Dr Lytle, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, F-25, Cleveland, OH 44195, USA
e-mail: lytleb@ccf.org

Presented at the Heart Failure & Circulatory Support Summit, Cleveland, OH, Aug 22–25, 2002.

The first 300 words of the full text of this article appear below.

For patients with significant coronary artery disease, abnormal left ventricular (LV) function has predicted an increased risk of death without myocardial revascularization. Natural history studies performed before the advent of coronary bypass surgery established this principle and subsequent comparative studies have confirmed it [1–6]. Soon after the advent of coronary bypass surgery a series of randomized and comparative observational studies were undertaken that compared the strategy of initial bypass surgery with initial medical management followed by surgery if symptoms worsened. Two randomized studies of patients with mild to moderate chronic stable angina, the VA Cooperative Study and the Coronary Artery Surgery Study (CASS), contained patients with abnormal left ventricular function (ejection fraction < 50%) [2–4].

In the VA Cooperative Study abnormal left ventricular function and three-vessel disease defined a "high risk" group of patients for whom bypass surgery improved the long-term survival rate. Also in the randomized portion of CASS surgery improved the survival rate of patients with ischemic cardiomyopathy and triple-vessel disease at least out to 10 years after operation. A meta-analysis of these and other smaller randomized trials confirmed the survival benefit of bypass surgery for patients with abnormal LV function [7]. Studies involving the CASS Registry, a nonrandomized portion of the CASS study that contained larger numbers of patients than the randomized arm and contained patients with mild or severe symptoms, showed that surgery prolonged the survival rate of patients with triple-vessel disease and abnormal LV function whether they had mild or severe angina [5, 6]. Other important CASS registry analyses showed that bypass surgery decreased the risk of sudden death for patients with abnormal LV function and that the surgical strategy of complete revascularization was important for patients with ischemic cardiomyopathy [8, . . . [Full Text of this Article]






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