Survival following coronary angioplasty versus coronary artery bypass surgery in anatomic subsets in which coronary artery bypass surgery improves survival compared with medical therapy - Results from the Bypass Angioplasty Revascularization Investigation (BARI)
Pb. Berger et al., Survival following coronary angioplasty versus coronary artery bypass surgery in anatomic subsets in which coronary artery bypass surgery improves survival compared with medical therapy - Results from the Bypass Angioplasty Revascularization Investigation (BARI), J AM COL C, 38(5), 2001, pp. 1440-1449
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
OBJECTIVES We sought to compare survival after coronary artery bypass graft
(CABG) and percutaneous transluminal coronary angioplasty (PTCA) in high-r
isk anatomic subsets.
BACKGROUND Compared with medical therapy, CABG decreases mortality in patie
nts with three-vessel disease and two-vessel disease involving the proximal
left anterior descending artery (LAD), particularly if left ventricular (L
V) dysfunction is present. flow survival after PTCA and CABG compares in th
ese high-risk anatomic subsets is unknown.
METHODS In the Bypass Angioplasty Revascularization Investigation (BARI), 1
,829 patients with multivessel disease were randomized to an initial strate
gy of PTCA or CABG between 1988 and 1991. Stents and IIb/IIIa inhibitors we
re not utilized. Since patients in BARI with diabetes mellitus had greater
survival with CABG, separate analyses of patients without diabetes were per
RESULTS Seven-year survival among patients with three-vessel disease underg
oing PTCA and CABG (n = 754) was 79% versus 84% (p = 0.06), respectively, a
nd 85% versus 87% (p = 0.36) when only non-diabetics (n = 592) were analyze
d. In patients with three-vessel disease and reduced LV function (ejection
fraction <50%), seven-year survival was 70% versus 74% (p = 0.6) in an PTCA
and CABG patients (n = 176), and 82% versus 73% (p = 0.29) among non-diabe
tic patients (n = 124). Seven-year survival was 87% versus 84% (p = 0.9) in
an PTCA and CABG patients (including diabetics) with two-vessel disease in
volving the proximal LAD (n = 352), and 78% versus 71% (p = 0.7) in patient
s with two-vessel disease involving the proximal LAD with reduced LV functi
on (n = 72).
CONCLUSION In high-risk anatomic subsets in which survival is prolonged by
CABG versus medical therapy, revascularization by PTCA and CABG yielded equ
ivalent survival over seven years. (J Am Coll Cardiol 2001;38:1440-9) (C) 2
001 by the American College of Cardiology.