Ischemic cardiomyopathy: The myopathy of coronary artery disease: Natural history and results of medical versus surgical treatment

Clinical, hemodynamic and angiographic data were analyzed in 66 patients with coronary artery disease and severe generalized left ventricular dysfunction (ischemic cardiomyopathy) in order to determine their prognosis and examine the results of medical and surgical management. Seventy-six percent of patients had angina, 85 percent a history of one or more myocardial infarctions, 73 percent cardiomegaly, 38 percent mitral regurgitation, 98 percent severe stenosis of two or three major coronary arteries, and 100 percent a left ventricular ejection fraction of 25 percent or less. Forty-two patients were managed medically, and 24 surgically with aortocoronary bypass grafts or ventricular plication, or both. The clinical and hemodynamic findings in both groups were nearly identical. In a follow-up period of 12 months, the mortality rate was 31 percent in the medical group and 50 percent in the surgical group, with 83 percent of the surgical deaths occurring within 1 month of operation. There was no significant difference in the functional status of medical and surgical survivors. Regardless of therapy, patients with mitral regurgitation or a left ventricular end-diastolic pressure of 24 mm Hg or greater had a significantly higher mortality rate than patients without these findings. This study indicates that patients with ischemic cardiomyopathy have a poor prognosis, and surgical intervention with current available techniques has a high operative mortality rate without significantly altering the symptoms in the survivors.