Ten-year follow-up of quality of life in patients randomized to receive medical therapy or coronary artery bypass graft surgery. The Coronary Artery Surgery Study (CASS)

Abstract

Quality of life indexes were assessed in 780 patients 10 years after randomization to medical therapy (n=390) or coronary artery bypass graft surgery (n=390) in the Coronary Artery Surgery Study. At 10 years, mortality was 21.8% in the medical group and 19.2% in the surgical group (p=NS), and 144 (37%) of the medical group had undergone surgery because of increasing chest pain. At study entry, 22% of medical and surgical patients were angina free; at 1 and 5 years after entry, the frequency of asymptomatic patients was 66% and 63% in the surgical group and 30%7s and 381% in the medical group. However, by 10 years after entry, the proportion of patients free of angina had fallen to 47% in the surgical group and to 42% in the medical group. Activity limitation and use of f3-blockers and long-acting nitrates were less in the surgical than the medical group at 1 and 5 years after entry but little different from the medical group at 10 years after entry. Throughout follow-up, recreational status, employment status, frequency of heart failure, use of other medications, and hospitalization frequency were similar between the two groups.

Preoperative Intra-Aortic Balloon Counterpulsation in Coronary Artery Bypass Graft Patients with Severe Left Ventricular Dysfunction

“…In recent years, the device installed on myocardial revascularization preoperative in patients with severe cardiomyopathy has been shown as an important impact strategy to reduce morbid-mortality [2]- [4]. On the other hand, the IABP use is related to some complications, such as thromboembolism, ischemic lesions that depend, mainly, on the permanence time of the IABP and the surgeon's skill in the catheter installation [5] [6].…”

Avaliação da adequação do controle de fatores de risco cardiovascular após cirurgia de revascularização miocárdica

“…The myocardial revascularization surgery (MRS), an invasive and highly complex procedure for the treatment of coronary atherosclerosis, promotes symptom relief, improves the tolerance to physical exercises and increases survival in the more severe cases of the disease 1 . After a while, however, these patients can present progression of the atherosclerosis in the native arteries as well as in the grafts, considering that the surgery exercises only a mechanical bypass action on the atherosclerosis plaques and does not act on the etiopathogenic factors of the disease.…”

O uso do balão intra-aórtico no pré-operatório de cirurgia de revascularização miocárdica, associada à disfunção ventricular grave

“…The stenosis of the left coronary trunk, surgical coronary reintervention, unstable angina and low ejection fraction of the left ventricle have been identifi ed in previous studies, as risk factors for the worst post-operative prognosis 4,5 . However, patients with decreased left ventricle ejection fraction are among those that can benefi t the most, in time, from the surgical treatment 6 .…”