HCFI Update: Opt for medical treatment for heart blockages with low left heart functions

For most patients with systolic left heart pumping function (LVEF) of 35 percent or less and coronary heart blockages amenable to bypass surgery one should first initiate optimal medical therapy alone rather than medical therapy plus bypass surgery, said Padmashri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

Earlier view had been that compared with medical therapy, surgical bypass of viable heart muscle improves both survival and left heart function. This view was based on the fact that up to 50 percent of patients with left heart pumping dysfunction due to coronary heart blockages have a significant amount of viable heart muscles.

The results of Surgical Treatment for Ischemic Heart Failure (STICH), a randomized trial have shown that compared with optimal medical therapy alone, optimal medical therapy plus bypass surgery resulted in no significant improvement in the primary outcome of all-cause mortality at a median follow-up of 56.

The current recommendation that one should initiate optimal medical therapy alone rather than optimal medical therapy plus bypass surgery is based upon the significant morbidity associated with bypass surgery. Bypass surgery, however, is preferred by patients with ongoing anginal symptoms despite optimal medical therapy.