J-SAP Study 1-2: Outcomes of Patients With Stable High-Risk Coronary Artery Disease Receiving Medical-Preceding Therapy in Japan A Comparison With CABG-Preceding Therapy

• Published in: Circulation Journal Vol. 70; no. 8; pp. 1012 - 1016
• Main Authors: Fukunishi, Masanori, Nishigaki, Kazuhiko, Okubo, Munenori, Kawasaki, Masanori, Takemura, Genzou, Minatoguchi, Shinya, Fujiwara, Hisayoshi
• Format: Journal Article
• Language: English
• Published: The Japanese Circulation Society 2006
• Subjects: Coronary artery bypass grafting; High-risk coronary artery disease; Medical-preceding therapy
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.70.1012

Background Stable coronary artery disease (CAD) is classified into 2 types: high-risk (ie, 3-vessel disease, left main trunk lesions, or ostial lesions of the left anterior descending (LAD)) and low-risk (1- or 2-vessel disease other than ostial lesions of the LAD). Generally, the former is treated with coronary artery bypass grafting-preceding therapy (CABG), but not medical-preceding therapy (Medical); however, this is based on evidence from 30 years ago or more and does not reflect the recent progression of Medical and CABG. In addition, a randomized study has not been performed in Japan. Methods and Results In high-risk CAD, the long-term outcomes of 77 Medical patients and age-, sex-, coronary-lesion-, symptom- and risk-factor-matched 99 CABG patients were surveyed over 3 years (mean: 3.4 years) starting in 2000 at 37 nationwide hospitals. The incidences of cardiac death and cardiac death + non-fatal acute coronary syndrome (9.1% and 11.7% in Medical, and 2.0% and 3.0% in CABG, respectively) were significantly higher and the improvement in clinical symptoms was significantly lower in Medical than CABG. Conclusions CABG is recommended in patients with high-risk CAD from the view of long-term prognosis; however, it should be remembered that the long-term outcome in Medical has considerably improved. (Circ J 2006; 70: 1012 - 1016)