OBJECTIVES: We sought to compare survival after coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) in high-risk anatomic subsets. BACKGROUND: Compared with medical therapy, CABG decreases mortality in patients with three-vessel disease and two-vessel disease involving the proximal left anterior descending artery (LAD), particularly if left ventricular (LV) dysfunction is present. How survival after PTCA and CABG compares in these 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 strategy of PTCA or CABG between 1988 and 1991. Stents and IIb/IIIa inhibitors were not utilized. Since patients in BARI with diabetes mellitus had greater survival with CABG, separate analyses of patients without diabetes were performed. RESULTS:Seven-year survival among patients with three-vessel disease undergoing PTCA and CABG (n = 754) was 79% versus 84% (p = 0.06), respectively, and 85% versus 87% (p = 0.36) when only non-diabetics (n = 592) were analyzed. In patients with three-vessel disease and reduced LV function (ejection fraction <50%), seven-year survival was 70% versus 74% (p = 0.6) in all PTCAand CABG patients (n = 176), and 82% versus 73% (p = 0.29) among non-diabetic patients (n = 124). Seven-year survival was 87% versus 84% (p = 0.9) in all PTCAand CABG patients (including diabetics) with two-vessel disease involving the proximal LAD (n = 352), and 78% versus 71% (p = 0.7) in patients with two-vessel disease involving the proximal LAD with reduced LV function (n = 72). CONCLUSION: In high-risk anatomic subsets in which survival is prolonged by CABG versus medical therapy, revascularization by PTCA and CABG yielded equivalent survival over seven years.
RCT Entities:
OBJECTIVES: We sought to compare survival after coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) in high-risk anatomic subsets. BACKGROUND: Compared with medical therapy, CABG decreases mortality in patients with three-vessel disease and two-vessel disease involving the proximal left anterior descending artery (LAD), particularly if left ventricular (LV) dysfunction is present. How survival after PTCA and CABG compares in these 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 strategy of PTCA or CABG between 1988 and 1991. Stents and IIb/IIIa inhibitors were not utilized. Since patients in BARI with diabetes mellitus had greater survival with CABG, separate analyses of patients without diabetes were performed. RESULTS: Seven-year survival among patients with three-vessel disease undergoing PTCA and CABG (n = 754) was 79% versus 84% (p = 0.06), respectively, and 85% versus 87% (p = 0.36) when only non-diabetics (n = 592) were analyzed. In patients with three-vessel disease and reduced LV function (ejection fraction <50%), seven-year survival was 70% versus 74% (p = 0.6) in all PTCA and CABG patients (n = 176), and 82% versus 73% (p = 0.29) among non-diabeticpatients (n = 124). Seven-year survival was 87% versus 84% (p = 0.9) in all PTCA and CABG patients (including diabetics) with two-vessel disease involving the proximal LAD (n = 352), and 78% versus 71% (p = 0.7) in patients with two-vessel disease involving the proximal LAD with reduced LV function (n = 72). CONCLUSION: In high-risk anatomic subsets in which survival is prolonged by CABG versus medical therapy, revascularization by PTCA and CABG yielded equivalent survival over seven years.
Authors: Joshua M Stolker; Dazhong Sun; Darcy G Conaway; Philip G Jones; Frederick A Masoudi; Pamela N Peterson; Harlan M Krumholz; Mikhail Kosiborod; John A Spertus Journal: Am J Cardiol Date: 2010-02-20 Impact factor: 2.778
Authors: Giuseppe Biondi-Zoccai; Imad Sheiban; Claudio Moretti; Tullio Palmerini; Antonio Marzocchi; Davide Capodanno; Corrado Tamburino; Massimo Margheri; Giuseppe Vecchi; Giuseppe Sangiorgi; Andrea Santarelli; Antonio L Bartorelli; Carlo Briguori; Luigi Vignali; Francesco di Pede; Angelo Ramondo; Massimo Medda; Marco de Carlo; Giovanni Falsini; Alberto Benassi; Cataldo Palmieri; Vincenzo Filippone; Diego Sangiorgi; Fabio Barlocco; Stefano de Servi Journal: Clin Res Cardiol Date: 2010-12-03 Impact factor: 5.460
Authors: Martin Russ; Karl Werdan; Jochen Cremer; Arno Krian; Thomas Meinertz; Hans-Reinhard Zerkowski Journal: Dtsch Arztebl Int Date: 2009-04-10 Impact factor: 5.594
Authors: Michał Hawranek; Michal O Zembala; Mariusz Gasior; Tomasz Hrapkowicz; Łukasz Pyka; Daniel Cieśla; Marian Zembala Journal: Oncotarget Date: 2018-04-20