Left main-stem coronary artery disease: surgical versus medical management.

The survival of surgically and medically treated patients with left main-stem coronary artery stenosis has been analysed in detail. From 1978 to 1981, 85 patients with stenosis of the left main coronary artery greater than 50% were divided into two groups; 47 were treated surgically and 38 medically. Left ventricular function, previous myocardial infarction, associated right coronary artery occlusion and extent of the left main coronary artery disease were analysed using the chi 2 and independent Student's t-tests. These important variables were comparable in both groups. Severity of angina in the two groups both pre- and postmanagement were compared using the chi 2 test and Stuart-Maxwell test. These showed that the majority of surgically treated patients improved markedly as compared with the medically treated group. Survival was examined using the Kaplan-Meier product limit estimate. The difference between the survival curves was statistically significant (p less than 0.005, generalized Wilcoxon and Savage tests), with the surgical group having the more favourable outcome. One-year and 2-year survival for the surgically treated group was 97.8% and 91.3%, compared with 79.9% and 74.9% for the medically treated group.