|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2000; 35:1116-1121 © 2000 by the American College of Cardiology Foundation |
* Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, Georgia, USA
Emory University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Atlanta, Georgia, USA
Emory University School of Medicine, Department of Biostatistics, Emory University School of Public Health, Atlanta, Georgia, USA
Manuscript received April 22, 1999; revised manuscript received September 20, 1999, accepted December 17, 1999.
Reprint requests and correspondence: Dr. Spencer B. King, III, Emory University Hospital, Suite F606, 1364 Clifton Road Northeast, Atlanta, Georgia 30322
OBJECTIVES
To evaluate the long-term outcome of patients randomized to coronary bypass surgery or coronary angioplasty.
BACKGROUND
The Emory Angioplasty versus Surgery Trial (EAST) is a single center randomized comparison of a strategy of initial coronary angioplasty (n = 198) or coronary bypass surgery (n = 194) for patients with multivessel coronary artery disease. The primary end point (death, myocardial infarction or a large ischemic defect at 3 years) was not different, and repeat revascularization was significantly greater in the angioplasty group. Subsequently, the National Heart, Lung and Blood Institute supported a five-year extension of the trial.
METHODS
After the three year anniversary visit, annual questionnaires, telephone contact and examination of medical records were accomplished until death or the eight year anniversary in 100% of the patients surviving at 3 years.
RESULTS
Survival at 8 years is 79.3% in the angioplasty group and 82.7% in the surgical group (p = 0.40). Patients with proximal left anterior descending stenosis and those with diabetes tended to have better late survival with surgical intervention although not reaching statistical significance. After the first 3 years, repeat interventions remained relatively equal for both treatment groups.
CONCLUSIONS
Long-term survival is not significantly different between angioplasty and surgery, and late (three to eight year) revascularization procedures were infrequent. Patients without treated diabetes had similar survival in both groups.
| ||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  J. Daemen, E. Boersma, M. Flather, J. Booth, R. Stables, A. Rodriguez, G. Rodriguez-Granillo, W. A. Hueb, P. A. Lemos, and P. W. Serruys Long-Term Safety and Efficacy of Percutaneous Coronary Intervention With Stenting and Coronary Artery Bypass Surgery for Multivessel Coronary Artery Disease: A Meta-Analysis With 5-Year Patient-Level Data From the ARTS, ERACI-II, MASS-II, and SoS Trials Circulation, September 9, 2008; 118(11): 1146 - 1154. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Bravata, A. L. Gienger, K. M. McDonald, V. Sundaram, M. V. Perez, R. Varghese, J. R. Kapoor, R. Ardehali, D. K. Owens, and M. A. Hlatky Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery Ann Intern Med, November 20, 2007; 147(10): 703 - 716. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons and S. D. Fihn Coronary Revascularization: New Evidence, New Challenges Ann Intern Med, November 20, 2007; 147(10): 732 - 734. [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF]
|
|
|
|
|
|
J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): 652 - 726. [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Holmes Jr, L. J. Kim, M. M. Brooks, K. E. Kip, H. V. Schaff, K. M. Detre, R. L. Frye, and Bypass Angioplasty Revascularization Investigation The effect of coronary artery bypass grafting on specific causes of long-term mortality in the Bypass Angioplasty Revascularization Investigation J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 38 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Rao, O. Aziz, S. S. Panesar, C. Jones, S. Morris, A. Darzi, and T. Athanasiou Cost effectiveness analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery BMJ, March 24, 2007; 334(7594): 621 - 621. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Berry, J.-C. Tardif, and M. G. Bourassa Coronary Heart Disease in Patients With Diabetes: Part II: Recent Advances in Coronary Revascularization J. Am. Coll. Cardiol., February 13, 2007; 49(6): 643 - 656. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Ben-Gal, Y. Moshkovitz, N. Nesher, G. Uretzky, R. Braunstein, A. Hendler, E. Zivi, I. Herz, and R. Mohr Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Patients with Diabetes Mellitus Ann. Thorac. Surg., November 1, 2006; 82(5): 1692 - 1697. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. B. Barner Status of percutaneous coronary intervention and coronary artery bypass. Eur. J. Cardiothorac. Surg., September 1, 2006; 30(3): 419 - 424. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Guyton Coronary Artery Bypass is Superior to Drug-Eluting Stents in Multivessel Coronary Artery Disease Ann. Thorac. Surg., June 1, 2006; 81(6): 1949 - 1957. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Kaehler, R. Koester, W. Billmann, C. Schroeder, H.-J. Rupprecht, T. Ischinger, R. Jahns, A. Vogt, M. Lampen, R. Hoffmann, et al. 13-year follow-up of the German angioplasty bypass surgery investigation Eur. Heart J., October 2, 2005; 26(20): 2148 - 2153. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. King III, G. Dangas, J. W. Moses, S. B. King III, G. Dangas, and J. W. Moses Surgery Is Preferred for the Diabetic With Multivessel Disease Circulation, September 6, 2005; 112(10): 1500 - 1515. [Full Text] [PDF]
|
|
|
|
|
|
A. M. Calafiore, M. Di Mauro, G. Di Giammarco, G. Teodori, A. L. Iaco, V. Mazzei, G. Vitolla, and M. Contini Single Versus Bilateral Internal Mammary Artery for Isolated First Myocardial Revascularization in Multivessel Disease: Long-Term Clinical Results in Medically Treated Diabetic Patients Ann. Thorac. Surg., September 1, 2005; 80(3): 888 - 895. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Malenka, B. J. Leavitt, M. J. Hearne, J. F. Robb, Y. R. Baribeau, T. J. Ryan, R. E. Helm, M. A. Kellett, H. L. Dauerman, L. J. Dacey, et al. Comparing Long-Term Survival of Patients With Multivessel Coronary Disease After CABG or PCI: Analysis of BARI-Like Patients in Northern New England Circulation, August 30, 2005; 112(9_suppl): I-371 - I-376. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. L. Hannan, M. J. Racz, G. Walford, R. H. Jones, T. J. Ryan, E. Bennett, A. T. Culliford, O. W. Isom, J. P. Gold, and E. A. Rose Long-Term Outcomes of Coronary-Artery Bypass Grafting versus Stent Implantation N. Engl. J. Med., May 26, 2005; 352(21): 2174 - 2183. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. T. van Domburg, J. J.M. Takkenberg, L. J. Noordzij, F. Saia, L. A. van Herwerden, P. W.J.C. Serruys, and A. J.J.C. Bogers Late Outcome After Stenting or Coronary Artery Bypass Surgery for the Treatment of Multivessel Disease: A Single-Center Matched-Propensity Controlled Cohort Study Ann. Thorac. Surg., May 1, 2005; 79(5): 1563 - 1569. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Flaherty and C. J. Davidson Diabetes and Coronary Revascularization JAMA, March 23, 2005; 293(12): 1501 - 1508. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Hlatky, D. B. Boothroyd, K. A. Melsop, M. M. Brooks, D. B. Mark, B. Pitt, G. S. Reeder, W. J. Rogers, T. J. Ryan, P. L. Whitlow, et al. Medical Costs and Quality of Life 10 to 12 Years After Randomization to Angioplasty or Bypass Surgery for Multivessel Coronary Artery Disease Circulation, October 5, 2004; 110(14): 1960 - 1966. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Pfisterer and for the TIME Investigators Long-Term Outcome in Elderly Patients With Chronic Angina Managed Invasively Versus by Optimized Medical Therapy: Four-Year Follow-Up of the Randomized Trial of Invasive Versus Medical Therapy in Elderly Patients (TIME) Circulation, September 7, 2004; 110(10): 1213 - 1218. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Lichtenberg, U. Klima, H. Paeschke, M. Pichlmaier, S. Ringes-Lichtenberg, T. Walles, H. Goerler, and A. Haverich Impact of multivessel coronary artery disease on outcome after isolated minimally invasive bypass grafting of the left anterior descending artery Ann. Thorac. Surg., August 1, 2004; 78(2): 487 - 491. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Lichtenberg, U. Klima, H. Paeschke, M. Pichlmaier, S. Ringes-Lichtenberg, T. Walles, H. Goerler, and A. Haverich Impact of diabetes on outcome following isolated minimally invasive bypass grafting of the left anterior descending artery Ann. Thorac. Surg., July 1, 2004; 78(1): 129 - 134. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. E. Boden Surgery, angioplasty, or medical therapy for symptomatic multivessel coronary artery disease: Is there an indisputable "winning strategy" from evidence-based clinical trials? J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1752 - 1754. [Full Text] [PDF]
|
|
|
|
|
|
G. W. Vetrovec Don't blame the stents J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1355 - 1357. [Full Text] [PDF]
|
|
|
|
|
|
O. Lev-Ran, R. Mohr, D. Pevni, N. Nesher, Y. Weissman, D. Loberman, and G. Uretzky Bilateral internal thoracic artery grafting in diabetic patients: Short-term and long-term results of a 515-patient series J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1145 - 1150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. M.G. Legrand, P. W. Serruys, F. Unger, B. A. van Hout, M. C.M. Vrolix, G. M.P. Fransen, T. T. Nielsen, P. K. Paulsen, R. S. Gomes, J. M.G. de Queiroz e Melo, et al. Three-Year Outcome After Coronary Stenting Versus Bypass Surgery for the Treatment of Multivessel Disease Circulation, March 9, 2004; 109(9): 1114 - 1120. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Casey and D. P Faxon Multi-vessel coronary disease and percutaneous coronary intervention Heart, March 1, 2004; 90(3): 341 - 346. [Full Text] [PDF]
|
|
|
|
|
|
N. E.J. West, P. N. Ruygrok, C. M.C. Disco, M. W.I. Webster, W. K. Lindeboom, W. W. O'Neill, N. F. Mercado, and P. W. Serruys Clinical and Angiographic Predictors of Restenosis After Stent Deployment in Diabetic Patients Circulation, February 24, 2004; 109(7): 867 - 873. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Holmes Jr, B. G. Firth, and D. L. Wood Paradigm shifts in cardiovascular medicine J. Am. Coll. Cardiol., February 18, 2004; 43(4): 507 - 512. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Abizaid, M. A. Costa, D. Blanchard, M. Albertal, H. Eltchaninoff, G. Guagliumi, L. Geert-Jan, A. S. Abizaid, A. G.M.R. Sousa, E. Wuelfert, et al. Sirolimus-eluting stents inhibit neointimal hyperplasia in diabetic patients: Insights from the RAVEL Trial Eur. Heart J., January 2, 2004; 25(2): 107 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. T. Hurst and R. W. Lee Increased Incidence of Coronary Atherosclerosis in Type 2 Diabetes Mellitus: Mechanisms and Management Ann Intern Med, November 18, 2003; 139(10): 824 - 834. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Henderson, S. J. Pocock, T. C. Clayton, R. Knight, K. A. A. Fox, D. G. Julian, D. A. Chamberlain, and Second Randomized Intervention Treatment of Angina Seven-year outcome in the RITA-2 trial: coronary angioplasty versus medical therapy J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1161 - 1170. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Endo, Y. Tomizawa, and H. Nishida Bilateral Versus Unilateral Internal Mammary Revascularization in Patients With Diabetes Circulation, September 16, 2003; 108(11): 1343 - 1349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. K. Wolf, E. L. Alderman, M. P. Caskey, A. R. Raczkowski, M. K. Dullum, D. C. Lundell, A. C. Hill, N. Wang, and M. A. Daniel Clinical and six-month angiographic evaluation of coronary arterial graft interrupted anastomoses by use of a self-closing clip device: a multicenter prospective clinical trial J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 168 - 177. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.-H. Mak and D. P. Faxon Clinical studies on coronary revascularization in patients with type 2 diabetes Eur. Heart J., June 2, 2003; 24(12): 1087 - 1103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. N. Hoffman, J. A. TenBrook Jr, M. P. Wolf, S. G. Pauker, D. N. Salem, and J. B. Wong A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1293 - 1304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. McGuire, K. J. Anstrom, and E. D. Peterson Influence of the Bypass Angioplasty Revascularization Investigation National Heart, Lung, and Blood Institute Diabetic Clinical Alert on Practice Patterns: Results from the National Cardiovascular Network Database Circulation, April 15, 2003; 107(14): 1864 - 1870. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Lincoff Important Triad in Cardiovascular Medicine: Diabetes, Coronary Intervention, and Platelet Glycoprotein IIb/IIIa Receptor Blockade Circulation, March 25, 2003; 107(11): 1556 - 1559. [Full Text] [PDF]
|
|
|
|
 |
|
 I. L Williams, A. Vazir, and A. G Zaman Review: The management of stable angina in diabetes The British Journal of Diabetes & Vascular Disease, January 1, 2003; 3(1): 18 - 25. [Abstract] [PDF]
|
|
|
|
|
|
J. H. Cole, E. L. Jones, J. M. Craver, R. A. Guyton, D. C. Morris, J. S. Douglas Jr, Z. Ghazzal, and W. S. Weintraub Outcomes of repeat revascularization in diabetic patients with prior coronary surgery J. Am. Coll. Cardiol., December 4, 2002; 40(11): 1968 - 1975. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Michaels and K. Chatterjee Angioplasty Versus Bypass Surgery for Coronary Artery Disease Circulation, December 3, 2002; 106 (23): e187 - e190. [Full Text] [PDF]
|
|
|
|
|
|
P F Ludman Percutaneous coronary intervention in diabetics: time to consider "intimal remodelling therapy"? Heart, September 1, 2002; 88(3): 213 - 215. [Full Text] [PDF]
|
|
|
|
|
|
T. Ono, J. Kobayashi, Y. Sasako, K. o Bando, O. Tagusari, K. Niwaya, H. Imanaka, T. Nakatani, and S. Kitamura The impact of diabetic retinopathy on long-term outcome following coronary artery bypass graft surgery J. Am. Coll. Cardiol., August 7, 2002; 40(3): 428 - 436. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.J. de Feyter, P.W. Serruys, F. Unger, R. Beyar, V. de Valk, S. Milo, R. Simon, D. Regensburger, P.A. Crean, E. McGovern, et al. Bypass Surgery Versus Stenting for the Treatment of Multivessel Disease in Patients With Unstable Angina Compared With Stable Angina Circulation, May 21, 2002; 105(20): 2367 - 2372. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Kapur and I S Malik Is surgery still the preferred option for coronary revascularisation in diabetics with multivessel coronary disease? Heart, May 1, 2002; 87(5): 407 - 409. [Full Text] [PDF]
|
|
|
|
|
|
F.R. Eberli and B. Meier Coronary bypass surgery vs coronary angioplasty: a look to the past for new insights into the future Eur. Heart J., April 1, 2002; 23(7): 511 - 514. [Full Text] [PDF]
|
|
|
|
|
|
R.T van Domburg, D.P Foley, A Breeman, L.A van Herwerden, and P.W Serruys Coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty. Twenty-year clinical outcome Eur. Heart J., April 1, 2002; 23(7): 543 - 549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Abizaid, M. A. Costa, M. Centemero, A. S. Abizaid, V. M.G. Legrand, R. V. Limet, G. Schuler, F. W. Mohr, W. Lindeboom, A. G.M.R. Sousa, et al. Clinical and Economic Impact of Diabetes Mellitus on Percutaneous and Surgical Treatment of Multivessel Coronary Disease Patients: Insights From the Arterial Revascularization Therapy Study (ARTS) Trial Circulation, July 31, 2001; 104(5): 533 - 538. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Seabra-Gomes Every piece is important to build a puzzle. What can we learn from early experiences with balloon PTCA? Eur. Heart J., June 1, 2001; 22(11): 891 - 893. [PDF]
|
|
|
|
|
|
J P Pell, D Walsh, J Norrie, G Berg, A D Colquhoun, K Davidson, H Eteiba, A Faichney, A Flapan, K J Hogg, et al. Outcomes following coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in the stent era: a prospective study of all 9890 consecutive patients operated on in Scotland over a two year period Heart, June 1, 2001; 85(6): 662 - 666. [Abstract] [Full Text]
|
|
|
|
|
|
S. B. King III Coronary artery bypass graft or percutaneous coronary interventions in patients with diabetes: another nail in the coffin or "too close to call?" J. Am. Coll. Cardiol., March 15, 2001; 37(4): 1016 - 1018. [Full Text] [PDF]
|
|
|
|
|
|
B. E. Sobel Acceleration of Restenosis by Diabetes : Pathogenetic Implications Circulation, March 6, 2001; 103(9): 1185 - 1187. [Full Text] [PDF]
|
|
|
|
|
|
E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina) J. Am. Coll. Cardiol., September 1, 2000; 36(3): 970 - 1062. [Full Text] [PDF]
|
|
|
|
 |
|
 In EAST, Equal Survival at 8 Years with PTCA and CABG Journal Watch Cardiology, June 16, 2000; 2000(616): 6 - 6. [Full Text]
|
|
|
|
|
|
S. B. King III Acute myocardial infarction: are diabetics different? J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1513 - 1515. [Full Text] [PDF]
|
|
|
|
|
|
G. C. Friesinger II and J. A. Gavin III Diabetes and the cardiologists: a call to action J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1130 - 1133. [Full Text] [PDF]
|
|
|
|
|
|
K. E. Kip, E. L. Alderman, M. G. Bourassa, M. M. Brooks, L. Schwartz, D. R. Holmes Jr, R. M. Califf, P. L. Whitlow, B. R. Chaitman, and K. M. Detre Differential Influence of Diabetes Mellitus on Increased Jeopardized Myocardium After Initial Angioplasty or Bypass Surgery: Bypass Angioplasty Revascularization Investigation Circulation, April 23, 2002; 105(16): 1914 - 1920. [Abstract] [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
