Survival, XXXX , and employment status in a prospective randomized study of coronary bypass surgery.

@entity1 @entity16136 @entity66 @entity3657 @entity2791 @entity951 @entity583 @entity204
This report from the European Prospective Randomised Study presents 8 year results on survival and 5 year results on @entity583 and employment status. The 768 recruited @entity1 were all @entity1 under age 65 with mild or moderate @entity951 , 50% or greater stenosis in at least two major coronary arteries, and a left ventricular ejection fraction of 50% or greater. One "surgical" @entity1 was lost to follow-up immediately after randomization and is therefore excluded from the statistical analysis. Thus 394 @entity1 allocated to surgery were compared with 373 @entity1 allocated to medical treatment, regardless of what subsequently happened to the @entity1 . The policy of early surgery improved survival significantly compared with the conventional medical treatment policy in the total population (89% to 80%, respectively; p = .0013) and in the subgroup with @entity66 (92% and 77%, respectively; p = .00015). Reclassification of vessel disease by greater than 75% instead of 50% or greater stenosis as the criterion was undertaken to facilitate comparison of these results with those of other studies, which apply 70% or greater stenosis as the criterion of significant disease. Of the 767 @entity1 , a cohort of 711 were identified as having greater than 75% obstruction in one, two, or three vessels. A significant improvement in survival with surgery was found in the total cohort (89% and 80%, respectively; p = .0022), the subgroup with @entity66 (91% and 73%, respectively; p = .0044), and that with @entity16136 in which one of the diseased vessels was the proximal segment of the left anterior descending artery (LAD) (90% and 79%, respectively; p = .013). There was no significant difference in survival between the two treatments in @entity1 with @entity66 and those with @entity16136 without @entity2791 . Four noninvasive prognostic variables were independently predictive of the effect of surgery: resting electrocardiogram (in 767 @entity1 ), ST segment response to exercise (in 656), history and physical signs of @entity3657 (in 722), and age (in 767). A reduction in @entity204 was entirely responsible for the improved survival with surgery. The incidence of @entity583 in the medical group (11%) was not significantly different from that in the surgical group (15%). Repeat angiography in 71 @entity1 showed 6% graft closure between 1 and 5 years of follow-up. Surgery did not influence the gradually increasing annual rate of retirement from work.
