coronary artery bypass surgery versus medical treatment in patients with low ejection fraction and coronary artery disease

background: we compared the outcomes in patients with a low ejection fraction (ef) and multivessel coronary artery disease (cad) who either underwent coronary artery bypass grafting (cabg) or received medical treatment (mt) after a viability study via dobutamine stress echocardiography (dse). methods: we considered patients with cad and left ventricular ejection fraction (lvef) <40% who were referred for dse, and enrolled 106 patients (89% male, mean age: 55.8±9.7 years) with ≥4 viable segments. according to dse, all the 106 patients were suitable for revascularization. we compared the outcomes between the patients who underwent cabg and those who received mt at a mean follow-up time of 8 months. results: both groups had similar baseline characteristics and rest ef. thirty-three (31.1%) patients underwent cabg and 73 (68.9%) received mt. there was no significant difference between the cabg and mt groups in terms of mortality rate (9.1% vs. 11.0 %) and improvement in new york heart association functional class at follow-up. in the cabg group, patients with lvef ≤25% had higher mortality compared to patients with lvef >25% (100% vs. 40%, p< 0.05). conclusion: the patients with cad and a low ef had the same survival rate after both cabg and mt at mid-term follow-up. long-term follow-up is needed to show the survival benefit of cabg in such patients with an acceptable extent of viable myocardium.