Patients with ischemic cardiomyopathy who underwent coronary artery bypass grafting (CABG) in addition to receiving medical therapy had lower risk of death over 10 years than patients who only received medical therapy, according to a study published April 3 at ACC.16 in Chicago and published simultaneously in The New England Journal of Medicine.

In this trial update, Eric J. Velazquez, MD, and colleagues examined 1,212 patients with both an ejection fraction of 35 percent or less and coronary artery disease who were randomly assigned to undergo either CABG plus medical therapy or medical therapy alone. The primary outcome was death from any cause.

Death occurred in 58.9 percent of the CABG group and 66.1 percent of the medical-therapy group. The median survival was 7.73 years for the CABG group and 6.29 years for the medical-therapy group. The number needed to treat to prevent one death was 14 patients. Death from cardiovascular causes occurred in 40.5 percent of the CABG group and 49.3 percent of the medical-therapy group. Death from any cause or hospitalization for cardiovascular causes occurred in 76.6 percent of the CABG group and 87.0 percent of the medical-therapy group.

The authors had previously found that CABG was associated with a three-time higher risk of death within the first 30 days after randomization than with medical therapy alone, with similar differences in risk up to the second year of follow-up, but that a significant benefit began to accrue after two years. They write that the risks of performing CABG are offset by a durable effect that translates into an increasing clinical benefit seen for at least 10 years.

"The results of this trial should change our clinical approach to patients with heart failure. Early identification of a possible ischemic cause for left ventricular systolic dysfunction should be pursued with the potential of improving long-term survival through CABG," write Robert A. Guyton, MD, FACC and Andrew L. Smith, MD, FACC, in an editorial comment accompanying the paper. "In patients whose condition is suitable for coronary bypass, a discussion of the benefits observed in [this study] should be included in the model of shared decision-making among the cardiologist, the cardiac surgeon, and the patient."

Keywords: Heart Failure, Cardiomyopathies, Myocardial Ischemia, ACC Annual Scientific Session, Coronary Artery Bypass

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