Coronary Artery Bypass Surgery versus Medical Treatment in Patients with Low Ejection Fraction and Coronary Artery Disease

Background: We compared the outcomes in patients with a low ejection fraction (EF) and multivessel coronary artery disease (CAD) who either underwent coronary artery bypass grafting (CABG) or received medical treatment (MT) after a viability study via dobutamine stress echocardiography (DSE). Methods: We considered patients with CAD and left ventricular ejection fraction (LVEF) < 40% who were referred for DSE, and enrolled 106 patients (89% male, mean age: 55.8±9.7 years) with ?4 viable segments. According to DSE, all the 106 patients were suitable for revascularization. We compared the outcomes between the patients who underwent CABG and those who received MT at a mean follow-up time of 8 months. Results: Both groups had similar baseline characteristics and rest EF. Thirty-three (31.1%) patients underwent CABG and 73 (68.9%) received MT. There was no significant difference between the CABG and MT groups in terms of mortality rate (9.1% vs. 11.0 %) and improvement in New York Heart Association functional class at follow-up. In the CABG group, patients with LVEF > 25% had higher mortality compared to patients with LVEF > 25% (100% vs. 40%, P < 0.05). Conclusion: The patients with CAD and a low EF had the same survival rate after both CABG and MT at mid-term followup. Long-term follow-up is needed to show the survival benefit of CABG in such patients with an acceptable extent of viablemyocardium.