Principal Findings:

At 7 years, the CABG group had a significantly lower mortality compared to the medical therapy group (23% survival vs. 30%, p=0.043) but this benefit did not persist at 11 years (42% vs. 43%). There was no benefit at 7 or 11 years in patients without left main disease. At 11 years, surgery was beneficial in the following subgroups: 1.) three-vessel disease plus left ventricular dysfunction (50% vs. 62% mortality, p=0.026), 2.) clinically high-risk patients with 2 or more of the following: resting ST depression, history of MI, history of hypertension (51% vs. 64%, p=0.015) and 3.) combined angiographic and clinically high risk (46% vs. 76%, p = 0.005). High risk was defined as two or all of the following: ST depression of resting ECG, history of MI, history of hypertension. Patients with left ventricular dysfunction (ejection fraction <45%, end-diastolic pressure >14 mm Hg, or any contraction abnormality) benefited from surgery at 7 years (26% vs. 37%, p = 0.049) but not at 11 years (47% vs. 51%). Of note, the 30-day operative mortality rate is 5.8%. A subsequent 18-year follow-up report showed no benefit of surgery, even in the high-risk subgroups. Overall, the benefits of surgery began to diminish after 5 years, a time course that parallels the development of graft disease.