Principal Findings:

A trend toward lower mortality observed with CABG (1.1%/yr vs. 1.6%/yr) and was strongest in patients with ejection fraction ≤50% (p = 0.085) and three-vessel disease and ejection fraction ≤50% (p = 0.063). Among patients with three-vessel disease and ejection fraction of 35%–49%, there was a significant mortality benefit evident at subsequent follow-up [12% (CABG) vs. 35% mortality, p = 0.009; see N Engl J Med 1985;312:1665). At 10-year follow-up, 40% of medical patients had undergone CABG, and there was still no overall mortality difference (medical group 21%, surgical group 18%). Among patients with an EF <50%, CABG was associated with a mortality benefit (21% vs. 39%; p = 0.01). Among 912 patients with left main equivalent disease (e.g., severe proximal left anterior descending and left circumflex disease), long-term follow-up demonstrated that CABG prolonged life (13.1 vs. 6.2 years), but not if normal left ventricular function is present (15 year survival, 63% vs. 54%; p = NS). Follow-up of more than 16 years in CASS Registry patients with LMCD showed that CABG prolonged life in most clinical and angiographic subgroups. However, median survival was not prolonged by CABG in patients with normal LV systolic function.