CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
Argentine randomized study: coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple-vessel disease (ERACI II): 30-day and one-year follow-up results
Alfredo Rodriguez, MD, PhD, FACC*,
Victor Bernardi, MD*,
Jose Navia, MD, FACC*,
Julio Baldi, MD*,
Liliana Grinfeld, MD, FACC*,
Jorge Martinez, MD*,
Daniel Vogel, MD*,
Roberto Grinfeld, MD*,
Alejandro Delacasa, MD*,
Marcelo Garrido, MD*,
Raul Oliveri, MD*,
Eduardo Mele, MD, FACC*,
Igor Palacios, MD, FACC ,
William O’Neill, MD, FACC for the ERACI II Investigators
* Otamendi Hospital, Buenos Aires, Argentina
Massachusetts General Hospital, Boston, Massachusetts, USA
William Beaumont Hospital, Royal Oak, Michigan, USA
Manuscript received August 20, 1999;
revised manuscript received July 11, 2000,
accepted September 20, 2000.
Reprint requests and correspondence: Dr. William W. O’Neill, Division of Cardiology, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073
Woneill{at}Beaumont.edu
OBJECTIVES
The purpose of this study was to compare percutaneous transluminal coronary revascularization (PTCR) employing stent implantation to conventional coronary artery bypass graft surgery (CABG) in symptomatic patients with multivessel coronary artery disease.
BACKGROUND
Previous randomized studies comparing balloon angioplasty versus CABG have demonstrated equivalent safety results. However, CABG was associated with significantly fewer repeat revascularization procedures.
METHODS
A total of 2759 patients with coronary artery disease were screened at seven clinical sites, and 450 patients were randomly assigned to undergo either PTCR (225 patients) or CABG (225 patients). Only patients with multivessel disease and indication for revascularization were enrolled.
RESULTS
Both groups had similar clinical demographics: unstable angina in 92%; 38% were older than 65 years, and 23% had a history of peripheral vascular disease. During the first 30 days, PTCR patients had lower major adverse events (death, myocardial infarction, repeat revascularization procedures and stroke) compared with CABG patients (3.6% vs. 12.3%, p = 0.002). Death occurred in 0.9% of PTCR patients versus 5.7% in CABG patients, p < 0.013, and Q myocardial infarction (MI) occurred in 0.9% PTCR versus 5.7% of CABG patients, p < 0.013. At follow-up (mean 18.5 ± 6.4 months), survival was 96.9% in PTCR versus 92.5% in CABG, p < 0.017. Freedom from MI was also better in PTCR compared to CABG patients (97.7% vs. 93.4%, p < 0.017). Requirements for new revascularization procedures were higher in PTCR than in CABG patients (16.8% vs. 4.8%, p < 0.002).
CONCLUSIONS
In this selected high-risk group of patients with multivessel disease, PTCR with stent implantation showed better survival and freedom from MI than did conventional surgery. Repeat revascularization procedures were higher in the PTCR group.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | BARI | = Bypass Angioplasty Revascularization Investigation | | CABG | = coronary artery bypass graft surgery | | ERACI | = Argentine Randomized Study: Coronary Angioplasty vs. Coronary Bypass Surgery in Multivessel Disease | | ERACI II | = Argentine Randomized Study: Coronary Angioplasty with Stenting vs. Coronary Bypass Surgery in Multivessel Disease | | GABI | = German Angioplasty Bypass Investigation | | MACE | = major adverse cardiac events | | PTCA | = percutaneous transluminal coronary angioplasty | | PTCR | = percutaneous transluminal coronary revascularization |
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[Abstract]
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R. Mehran, G. D. Dangas, Y. Kobayashi, A. J. Lansky, G. S. Mintz, E. D. Aymong, M. Fahy, J. W. Moses, G. W. Stone, and M. B. Leon
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D. Orlic, E. Bonizzoni, G. Stankovic, F. Airoldi, A. Chieffo, N. Corvaja, G. Sangiorgi, M. Ferraro, C. Briguori, M. Montorfano, et al.
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[Abstract]
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P. B. Berger, M. H. Sketch Jr, and R. M. Califf
Choosing Between Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting for Patients With Multivessel Disease: What Can We Learn From the Arterial Revascularization Therapy Study (ARTS)?
Circulation,
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C Casey and D. P Faxon
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D. R. Holmes Jr, B. G. Firth, and D. L. Wood
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[Abstract]
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F. Eefting, H. Nathoe, D. van Dijk, E. Jansen, J. Lahpor, P. Stella, W. Suyker, J. Diephuis, H. Suryapranata, S. Ernst, et al.
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[Abstract]
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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
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[Abstract]
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A. Gimelli, M. Glauber, A. Giorgetti, G. Sambuceti, A. L'Abbate, and P. Marzullo
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J Gunn and D P Taggart
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K.-H. Mak and D. P. Faxon
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N. Freemantle, M. Calvert, J. Wood, J. Eastaugh, and C. Griffin
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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
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A Rodriguez, M Rodriguez Alemparte, J Baldi, J Navia, A Delacasa, D Vogel, R Oliveri, C Fernandez Pereira, V Bernardi, W O'Neill, et al.
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T. M. Sundt III, B. J. Gersh, and H. C. Smith
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L.A. Corr and R. Stables
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S. P. Sedlis, D. A. Morrison, J. D. Lorin, R. Esposito, G. Sethi, J. Sacks, W. Henderson, F. Grover, K. B. Ramanathan, D. Weiman, et al.
Percutaneous coronary intervention versus coronary bypass graft surgery for diabetic patients with unstable angina and risk factors for adverse outcomes with bypass: outcome of diabetic patients in the AWESOME randomized trial and registry
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C. A. Herzog, J. Z. Ma, and A. J. Collins
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V.S. Srinivas, M. M. Brooks, K. M. Detre, S. B. King III, A. K. Jacobs, J. Johnston, and D. O. Williams
Contemporary Percutaneous Coronary Intervention Versus Balloon Angioplasty for Multivessel Coronary Artery Disease: A Comparison of the National Heart, Lung and Blood Institute Dynamic Registry and the Bypass Angioplasty Revascularization Investigation (BARI) Study
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D.P. de Arenaza, A. Bakhai, and M. Flather
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A Kapur and I S Malik
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F.R. Eberli and B. Meier
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Investigators of the Department of Veterans Affair, the Angina With Extremely Serious Operative Mortal, D. A. Morrison, G. Sethi, J. Sacks, W. Henderson, F. Grover, S. Sedlis, R. Esposito, K. B. Ramanathan, et al.
Percutaneous coronary intervention versus coronary bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: the VA AWESOME multicenter registry: comparison with the randomized clinical trial
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F. J. Brennan
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I. F. Palacios and A. Rodriguez
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Stents vs. CABG for Multivessel Coronary Artery Disease
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T. J. Ryan
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