Long-Term Analysis of Left Ventricular Ejection Fraction in Patients With Stable Multivessel Coronary Disease Undergoing Medicine, Angioplasty or Surgery: 10-Year Follow-Up of the MASS II Trial

Study Questions:

What is the evolution of left ventricular ejection fraction (LVEF) in patients with stable coronary artery disease (CAD) treated by coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy?

Methods:

This was a post-hoc analysis of the MASS II trial with a follow-up of 10 years. LVEF was assessed with transthoracic echocardiography in patients with multivessel CAD, participants of the MASS II trial before randomization to CABG, PCI, or medical therapy alone (MT), and re-evaluated after 10 years of follow-up. To evaluate the behavior of groups along the evaluations (initial and 10 years), analysis of variance with repeated measures was used.

Results:

Of the 611 patients, 422 were alive after 10.32 ± 1.43 years. A total of 350 had LVEF reassessed: 108 patients from MT, 111 from CABG, and 131 from PCI. There was no difference in LVEF at the beginning (0.61 ± 0.07, 0.61 ± 0.08, and 0.61 ± 0.09, respectively, for PCI, CABG, and MT; p = 0.675) or at the end of follow-up (0.56 ± 0.11, 0.55 ± 0.11, and 0.55 ± 0.12; p = 0.675), or in the decline of LVEF (reduction delta of −7.2 ± 17.13, −9.08 ± 18.77, and −7.54 ± 22.74). Acute myocardial infarction (AMI) during the follow-up was associated with greater reduction in LVEF. The presence of previous AMI (odds ratio [OR], 2.50; 95% confidence interval [CI], 1.40-4.45; p = 0.0007) and during the follow-up (OR, 2.73; 95% CI, 1.25-5.92; p = 0.005) was associated with development of LVEF <45%.

Conclusions:

The authors concluded that regardless of the therapeutic option used, LVEF remains preserved in the absence of a major adverse cardiac event after 10 years of follow-up.

Perspective:

This study evaluated long-term evolution of LV function, which was initially preserved, in patients with multivessel CAD who underwent one of three therapeutic strategies: PCI, CABG, or MT. It appears that regardless of the treatment option, LVEF remained preserved at the end of follow-up, albeit with an overall significant modest decline. The current study demonstrated that initial MT was equivalent to revascularization procedures in respect to long-term evolution of LVEF, and that aggressive MT and lifestyle modifications with comprehensive risk factor control are valuable and its benefits should not be underestimated in the treatment of patients with stable multivessel CAD.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease, Interventions and Imaging, Echocardiography/Ultrasound

Keywords: Coronary Artery Disease, Myocardial Infarction, Follow-Up Studies, Cardiology, Stroke Volume, Ventricular Function, Risk Factors, Coronary Artery Bypass, Angioplasty, Echocardiography, Percutaneous Coronary Intervention


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