Comparison of coronary artery bypass surgery and medical therapy in patients 65 years of age or older. A nonrandomized study from the coronary artery surgery study (CASS) registry

B. J. Gersh, R. A. Kronmal, Hartzell V Schaff, R. L. Frye, T. J. Ryan, M. B. Mock, W. O. Myers, M. W. Athearn, A. J. Gosselin, G. C. Kaiser

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Abstract

We compared the results of coronary artery bypass surgery with those of medical therapy alone in 1491 nonrandomized patients 65 years of age or older. Cumulative survival at six years (adjusted for major differences in important base-line characteristics) was 79 per cent in the surgical group and 64 per cent in the medical group (P < 0.0001). At five years, chest pain was absent in 62 per cent of the surgical group and 29 per cent in the medical group (P < 0.0001). Analysis by the Cox proportional-hazards model suggested an independent beneficial effect of surgery on survival (P < 0.0001). Patients were divided into risk quartiles on the bases of preoperative predictors of survival identified by the Cox model. Surgical benefit was greatest in 'high-risk' patients (those in the two quartiles containing patients with the poorest prognosis). Among 234 'low-risk' patients with mild angina, relatively good ventricular function, and no left main coronary artey disease, there was no survival difference between those treated medically and those treated surgically. We conclude that in specific higher-risk subsets of non-randomized patients 65 years of age or older, coronary bypass surgery appeared to improve survival and symptoms in comparison with medical therapy alone. These conclusions must be tempered by consideration of the limitations of nonrandomized studies, particularly since patients in the two treatment groups differed substantially with regard to important base-line characteristics.

Original languageEnglish (US)
Pages (from-to)217-224
Number of pages8
JournalNew England Journal of Medicine
Volume313
Issue number4
StatePublished - 1985

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  • Medicine(all)

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Gersh, B. J., Kronmal, R. A., Schaff, H. V., Frye, R. L., Ryan, T. J., Mock, M. B., Myers, W. O., Athearn, M. W., Gosselin, A. J., & Kaiser, G. C. (1985). Comparison of coronary artery bypass surgery and medical therapy in patients 65 years of age or older. A nonrandomized study from the coronary artery surgery study (CASS) registry. New England Journal of Medicine, 313(4), 217-224.