Comparison of Treatment Outcomes in Off-pump Coronary Artery Bypass Graft and Medical Therapy in Patients with Triple-vessel Coronary Artery Disease and Severe Ventricular Dysfunction

Introduction: Heart failure is a major hazard for public health. Despite recent advance in medical therapy, there is not enough information on the outcome of offpump coronary artery bypass (OPCAB) and medical therapy on the patients with severe ventricular dysfunction and triplevessel (CAD). This study aimed to compare treatment outcomes and mortality rate in patients undergoing offpump coronary artery bypass (OPCAB) surgery and medical therapy who presented with severe ventricular dysfunction and triplevessel coronary artery disease (CAD). Materials and Methods: This retrospective cohort study was conducted on patients with severe ventricular dysfunction and triplevessel CAD during 20102011 in the Imam Ali Hospital of Kermanshah University of Medical Science. Patients were divided into two groups of medical therapy (group one) and OPCAB (group two). Followup data were collected after 30 months. Survival estimation was performed using KaplanMeier survival analysis and Cox regression model. Results: Of the 276 enrolled patients, 139(50.4%) underwent group one and 137(49.6%) group two. Study groups were homogenous in baseline characteristics, with the exception of hyperlipidemia (P=0.005). A significant difference was observed in cardiac mortality rates between the study groups (hazard ratio: 0.260 95% confidence interval: 0.1050.644 P=0.004). However, no significant difference was observed between the groups regarding the frequency of admission due to decompensate heart failure (P=0.17). In addition, the rate of admission due to acute coronary syndrome (ACS) in the first group was higher than the second group, significantly (P=0.001). Level of ejection fraction (EF) had a significant increase after coronary artery bypass graft (CABG) (28.50) compared to the preoperative stage (27.59) (P=0.042). However, no significant increase in the level of EF was observed in the first group before and after medical therapy (27.28 and 27.20, respectively) (P=0.83). Conclusion: According to the results of this study, the mortality rate associated with OPCAB was lower compared to medical therapy, ACS and EF enhancement in patients with triplevessel CAD and severe ventricular dysfunction.