Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study.

Abstract

The Coronary Artery Surgery Study (CASS) (Circulation 1990;82:1629-1646 T he Coronary Artery Surgery Study (CASS) sponsored by The National Heart, Lung, and Blood Institute is designed to assess the effect of coronary bypass surgery on mortality and

Indications for Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention in Chronic Stable Angina

“…Left internal thoracic artery conduits were used in only 14% of patients in the Coronary Artery Surgery Study. 3 CAD, 94% with normal ventricular function). Death or myocardial infarction occurred in 6.3% of PTCA patients and 3.3% of medical therapy patients (absolute difference, 3.0%; 95% confidence interval [CI], 0.4% to 5.7%; Pϭ0.02).…”

Trials and tribulations associated with angina and traditional therapeutic approaches

“…In these two subgroups the improved survival with CABGS became statistically significant at the follow-up mark of 84 months. 26,27 However, during the next analysis (at 120 months) in the subgroup with LVEF <50% + 3-vessel involvement the survival benefit of CABGS was found not significant anymore. Except for these findings there was no difference in mortality between the treatment arms in patients subgrouped by 1v, 2v, or 3v involvement.…”

“…27 However, further analysis of the CASS data in group-B patients (mild-moderate angina + LVEF >=35% but <50%) revealed improved mortality rates with CABGS compared to medical therapy. 26,27 Additionally, in the CASS study CABGS, compared to medical therapy, was associated with improved survival in the subgroup with LVEF <50% as well as in the subgroup with LVEF <50% + 3-vessel involvement. In these two subgroups the improved survival with CABGS became statistically significant at the follow-up mark of 84 months.…”

“…The VACSS 12,13 included patients with left main coronary (LMC) artery involvement; LMC + (abnormal left ventricular function (LVF) or normal LVF); no-LMC, 2v + abnormal LVF; 3v + abnormal LVF; 1v, 2v, 3v, impaired LVF, nonimpaired LVF; high angiographic risk (3v + impaired LVF); and low angiographic risk ( Using an intention to treat (ITT) analysis approach the VACSS, ECSS, and CASS trials revealed similar mortality rates between the main CABGS and medical therapy arms. 14,19,26,27 The ECSS is the only trial that showed on long-term follow-up a small, but statistically significant, improvement in mortality rate with CABGS. 19 The rates of fatal and nonfatal MI) in these trials were similar between the patients who underwent CABGS, compared to patient who did not undergo CABGS.…”

Cardiac service provision in the United Kingdom

“…12 As the applicability of PCI expanded, randomised data showed that surgical and percutaneous revascularisation were equivalent in terms of both survival and future risk of MI. 13 The latter strategy, however, would incorporate a greater likelihood of requiring a further intervention because of restenosis, but the introduction of routine stenting 14 -particularly with drug-eluting devices 15 -soon eroded this difference.…”