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Article
April 14, 1989

The Evolution of Medical and Surgical Therapy for Coronary Artery DiseaseA 15-Year Perspective

Author Affiliations

From the Departments of Medicine (Drs Califf, Hlatky, Mark, and Pryor), Community and Family Medicine (Drs Harrell, Lee, and Muhlbaier), and Surgery (Drs Rankin, Jones, Muhlbaier, and Oldham), Duke University Medical Center, Durham, NC.

From the Departments of Medicine (Drs Califf, Hlatky, Mark, and Pryor), Community and Family Medicine (Drs Harrell, Lee, and Muhlbaier), and Surgery (Drs Rankin, Jones, Muhlbaier, and Oldham), Duke University Medical Center, Durham, NC.

JAMA. 1989;261(14):2077-2086. doi:10.1001/jama.1989.03420140079032
Abstract

To elucidate the factors associated with improved survival following coronary artery bypass surgery, we studied 5809 patients receiving medical or surgical therapy for coronary artery disease. Three factors were associated with a significant surgical survival benefit: more severe coronary disease, a worse prognosis with medical therapy, and a more recent operative date. Patients with more extensive coronary obstruction had the greatest improvement in survival. Patients with a poor prognosis because of factors such as older age, severe angina, or left ventricular dysfunction had a reduction in risk that was proportionate to their overall risk on medical therapy. Survival with surgery progressively improved over the study period and by 1984 surgery was significantly better than medical therapy for most patient subgroups. Thus, contemporary coronary revascularization is associated with improved longevity in many patients with ischemic heart disease, especially in those with adverse prognostic indicators.

(JAMA. 1989;261:2077-2086)

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