INTERVENTIONAL CARDIOLOGY
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)
Peter B. Berger, MD, FACC*,*,
James L. Velianou, MD*,
Helen Aslanidou Vlachos, MSc ,
Frederick Feit, MD, FACC ,
Alice K. Jacobs, MD, FACC ,
David P. Faxon, MD, FACC||,
Michael Attubato, MD, FACC,
Norma Keller, MD, FACC,
Michael L. Stadius, MD, FACC¶,
Bonnie H. Weiner, MD, FACC#,
David O. Williams, MD, FACC**,
Katherine M. Detre, MD, DrPH on behalf of the BARI Investigators
* Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
University of Pittsburgh, Pittsburgh, Pennsylvania, USA
NYU Medical Center, New York, New York, USA
Boston Medical Center, Boston, Massachusetts, USA
|| University of Chicago, Chicago, Illinois, USA
¶ Seattle Veterans Administration Hospital, Seattle, Washington, USA
# University of Massachusetts Medical Center, Worcester, Massachusetts, USA
** Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
Manuscript received November 15, 2000;
revised manuscript received June 22, 2001,
accepted July 16, 2001.
* Reprint requests and correspondence: Dr. Peter Berger, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
berger.peter{at}mayo.edu
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-diabetic patients (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.
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Abbreviations and Acronyms
| | BARI | = Bypass Angioplasty Revascularization Investigation | | CABG | = coronary artery bypass graft | | EF | = ejection fraction | | IMA | = internal mammary artery | | LAD | = left anterior descending artery | | LV | = left ventricular | | MVD | = multivessel disease | | PTCA | = percutaneous transluminal coronary angioplasty | | TIMI | = Thrombolysis In Myocardial Infarction |
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