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 off-pump coronary artery bypass (OPCAB) and medical therapy on the patients with severe ventricular dysfunction and triple-vessel (CAD). This study aimed to compare treatment outcomes and mortality rate in patients undergoing off-pump coronary artery bypass (OPCAB) surgery and medical therapy who presented with severe ventricular dysfunction and triple-vessel coronary artery disease (CAD). Materials and Methods: This retrospective cohort study was conducted on patients with severe ventricular dysfunction and triple-vessel CAD during 2010-2011 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). Follow-up data were collected after 30 months. Survival estimation was performed using Kaplan-Meier 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: 0.105-0.644; 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 triple-vessel CAD and severe ventricular dysfunction.

Keywords:

Coronary Artery Disease , Medical Therapy , Off-Pump Coronary Artery Bypass Graft