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J Am Coll Cardiol, 1999; 33:63-72 © 1999 by the American College of Cardiology Foundation |
* State University of New York, University at Albany, Albany, New York, USA
Mid-America Heart Institute, Kansas City, Missouri, USA
Boston University School of Medicine, Boston, Massachusetts, USA
Buffalo General Hospital, Buffalo, New York, USA
|| New York Hospital-Cornell, New York, New York, USA
¶ Duke University Medical Center, Durham, North Carolina, USA
Manuscript received May 21, 1998; revised manuscript received August 3, 1998, accepted September 4, 1998.
Address for correspondence: Edward L. Hannan, PhD, Professor and Chair, Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York, University at Albany, One University Place, Rensselaer, New York 12144-3456
Objectives. The purpose of this study was to compare 3-year risk-adjusted survival in patients undergoing coronary artery bypass graft (CABG) surgery and percutaneous transluminal coronary angioplasty.
Background. Coronary artery bypass graft surgery and angioplasty are two common treatments for coronary artery disease. For referral purposes, it is important to know the relative pattern of survival after hospital discharge for these procedures and to identify patient characteristics that are related to survival.
Methods. New York’s CABG surgery and angioplasty registries were used to identify New York patients undergoing CABG surgery and angioplasty from January 1, 1993 to December 31, 1995. Mortality within 3 years of undergoing the procedure (adjusted for patient severity of illness) and subsequent revascularization within 3 years were captured. Three-year mortality rates were adjusted using proportional hazards methods to account for baseline differences in patients’ severity of illness.
Results. Patients with one-vessel disease with the one vessel not involving the left anterior descending artery (LAD) or with less than 70% LAD stenosis had a statistically significantly longer adjusted 3-year survival with angioplasty (95.3%) than with CABG surgery (92.4%). Patients with proximal LAD stenosis of at least 70% had a statistically significantly longer adjusted 3-year survival with CABG surgery than with angioplasty regardless of the number of coronary vessels diseased. Also, patients with three-vessel disease had a statistically significantly longer adjusted 3-year survival with CABG surgery regardless of proximal LAD disease. Patients with other one-vessel or two-vessel disease had no treatment-related differences in survival.
Conclusions. Treatment-related survival benefit at 3-years in patients with ischemic heart disease is predicted by the anatomic extent and specific site of the disease, as well as by the treatment chosen.
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