ABSTRACT
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