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

• Published in: European heart journal Vol. 34; no. 43; pp. 3370 - 3377
• Main Authors: Garzillo, Cibele Larrosa, Hueb, Whady, Gersh, Bernard J, Lima, Eduardo Gomes, Rezende, Paulo Cury, Hueb, Alexandre Ciappina, Vieira, Ricardo D'Oliveira, Favarato, Desiderio, Pereira, Alexandre Costa, Soares, Paulo Rogério, Serrano, Jr, Carlos Vicente, Ramires, José Antônio Franchini, Kalil Filho, Roberto
• Format: Journal Article
• Language: English
• Published: England 01.11.2013
• Subjects: Aged; Analysis of Variance; Cardiovascular Agents - therapeutic use; Coronary Artery Bypass; Coronary Stenosis - physiopathology; Coronary Stenosis - therapy; Echocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Infarction - etiology; Myocardial Infarction - physiopathology; Myocardial Revascularization - methods; Percutaneous Coronary Intervention; Stroke - etiology; Stroke - physiopathology; Stroke Volume - physiology; Treatment Outcome; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Coronary bypass surgery; Medical therapy; Percutaneous coronary intervention; Coronary artery disease; Left ventricular ejection fraction
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/eht201

Assuming that coronary interventions, both coronary bypass surgery (CABG) and percutaneous coronary intervention (PCI), are directed to preserve left ventricular function, it is not known whether medical therapy alone (MT) can achieve this protection. Thus, we evaluated the evolution of LV ejection fraction (LVEF) in patients with stable coronary artery disease (CAD) treated by CABG, PCI, or MT as a post hoc analysis of a randomized controlled trial with a follow-up of 10 years. Left ventricle ejection fraction was assessed with transthoracic echocardiography in patients with multivessel CAD, participants of the MASS II trial before randomization to CABG, PCI, or MT, and re-evaluated after 10 years of follow-up. Of the 611 patients, 422 were alive after 10.32 ± 1.43 years. Three hundred and fifty 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, 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, 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 (OR: 2.50, 95% 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%. Regardless of the therapeutic option applied, LVEF remains preserved in the absence of a major adverse cardiac event after 10 years of follow-up. http://www.controlled-trials.com. Registration number ISRCTN66068876.