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)

Citation
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
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
ISSN journal
0735-1097 → ACNP
Volume
38
Issue
5
Year of publication
2001
Pages
1440 - 1449
Database
ISI
SICI code
0735-1097(20011101)38:5<1440:SFCAVC>2.0.ZU;2-F
Abstract
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 formed. 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.