Close call: CABG versus medical therapy in CHD

CORONARY artery bypass surgery in addition to medical therapy may not be superior to medical therapy alone for patients with CHD and left ventricular dysfunction, a study suggests.

A randomised trial of 1200 relatively young patients (mean age 60 years) in 22 countries found little difference in the primary outcome – death from any cause – between a group receiving surgery plus medical therapy and those receiving medical therapy alone over five years.

Death was the outcome for 41% of the medical therapy group compared with 36% in the coronary artery bypass grafting (CABG) group.

Death from any cause or hospitalisation for cardiovascular causes occurred in 68% of the therapy-only group and 58% of the CABG group.

A New England Journal of Medicine editorial cautioned that selection of patients may have biased the study against CABG, but concluded: “We should be comfortable with the notion that, in general, surgery is not