Regular paperComparison 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)
Section snippets
Patient population
The study population comprised a subset of the 54,498 patients who underwent cardiac catheterization between July 1969 and February 1994 at Duke University Medical Center. Patient inclusion stopped in 1994 to allow time for long-term follow-up. Of these patients, the study group included those undergoing their first cardiac catheterization at Duke University in this time period who had ≥75% diameter stenosis in 1 of the 3 major epicardial vessels and an ejection fraction <40% with New York
Baseline characteristics:
Table 1lists baseline clinical characteristics of the 1,411 patients. Many of the baseline characteristics were similar in both groups. The median age in the medically treated group was 62 years, and 25% of the patients were aged >68, versus a median age of 63 in the CABG group, with 25% of the patients aged >68. Other important baseline clinical characteristics that were similar included the percentage of women, smoking history, hypertension, diabetes mellitus, hyperlipidemia, peripheral
Discussion
Although a number of observational series7, 8, 9, 10, 11, 12, 13, 14 have reported patient outcomes with coronary artery bypass grafting in patients with heart failure (Table 2), this study is the first large observational treatment comparison of the 25-year survival experience for CABG versus medical therapy in patients with coronary disease and clinical heart failure. The first major finding of this analysis is that regardless of the extent of coronary disease, CABG carries a significant
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