Revascularization in patients with moderate or severe left ventricular dysfunction

Patients with moderate to severe left ventricular systolic dysfunction and concomitant limiting angina may have improved survival and physical functioning after CABG.

A systematic review including 8 cohort studies of CABG vs. medical treatment with a total of 1 264 patients with an ejection fraction under 40% and angina undergoing CABG and 1 431 similar patients receiving medical treatment was abstracted in DARE. CABG appeared to improve survival compared to medical treatment, with a likely mortality reduction of between 30% and 50%. CABG also resulted in improved functional outcome, assessed as either improvement in ejection fraction or decrease in NYHA class. Operative mortality ranged from about 5% in patients younger than 60 years with mild heart failure without comorbid conditions to more than 30% in patients older than 70 years with severe ventricular dysfunction and comorbid conditions.

The following decision support rules contain links to this evidence summary:

• Reminder of revascularization in patients with angina and CHF

Ədəbiyyat

1. Baker DW, Jones R, Hodges J, Massie BM, Konstam MA, Rose EA. Management of heart failure. III. The role of revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction. JAMA 1994 Nov 16;272(19):1528-34.