comparison of treatment outcomes in off-pump coronary artery bypass graft and medical therapy in patients with triple-vessel coronary artery disease and severe ventricular dysfunction

introduction: heart failure is a major hazard for public health. despite recent advance in medical therapy, there is not enough information on the outcome of off-pump coronary artery bypass (opcab) and medical therapy on the patients with severe ventricular dysfunction and triple-vessel (cad). this study aimed to compare treatment outcomes and mortality rate in patients undergoing off-pump coronary artery bypass (opcab) surgery and medical therapy who presented with severe ventricular dysfunction and triple-vessel coronary artery disease (cad). materials and methods: this retrospective cohort study was conducted on patients with severe ventricular dysfunction and triple-vessel cad during 2010-2011 in the imam ali hospital of kermanshah university of medical science. patients were divided into two groups of medical therapy (group one) and opcab (group two). follow-up data were collected after 30 months. survival estimation was performed using kaplan-meier survival analysis and cox regression model. results: of the 276 enrolled patients, 139(50.4%) underwent group one and 137(49.6%) group two. study groups were homogenous in baseline characteristics, with the exception of hyperlipidemia (p=0.005). a significant difference was observed in cardiac mortality rates between the study groups (hazard ratio: 0.260; 95% confidence interval: 0.105-0.644; p=0.004). however, no significant difference was observed between the groups regarding the frequency of admission due to decompensate heart failure (p=0.17). in addition, the rate of admission due to acute coronary syndrome (acs) in the first group was higher than the second group, significantly (p=0.001). level of ejection fraction (ef) had a significant increase after coronary artery bypass graft (cabg) (28.50) compared to the preoperative stage (27.59) (p=0.042). however, no significant increase in the level of ef was observed in the first group before and after medical therapy (27.28 and 27.20, respectively) (p=0.83). conclusion: according to the results of this study, the mortality rate associated with opcab was lower compared to medical therapy, acs and ef enhancement in patients with triple-vessel cad and severe ventricular dysfunction.