JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
 QUICK SEARCH:   [advanced]


     


J Am Coll Cardiol, 2004; 43:1743-1751, doi:10.1016/j.jacc.2003.08.065
© 2004 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hueb, W.
Right arrow Articles by Ramires, J. A. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hueb, W.
Right arrow Articles by Ramires, J. A. F.

CLINICAL RESEARCH: CLINICAL TRIALS

The medicine, angioplasty, or surgery study (MASS-II): a randomized, controlled clinical trial of three therapeutic strategies for multivessel coronary artery disease

One-year results

Whady Hueb, MD*,*, Paulo R. Soares, MD*, Bernard J. Gersh, MB, ChB, DPhil{dagger}, Luiz A. M. César, MD*, Protásio L. Luz, MD, FACC*, Luiz B. Puig, MD*, Eulógio M. Martinez, MD, FACC*, Sergio A. Oliveira, MD* and José A. F. Ramires, MD, FACC*

* Heart Institute of the University of São Paulo, São Paulo, Brazil
{dagger} Mayo Clinic, Rochester, Minnesota, USA

Manuscript received February 17, 2003; revised manuscript received August 7, 2003, accepted August 15, 2003.

* Reprint requests and correspondence: Dr. Whady Hueb, Instituto do Coração, HC-FMUSP, Divisão Clinica, Av. Dr. Enéias de Carvalho Aguiar 44, Cerqueira César, São Paulo/SP, Brazil.
whady.hueb{at}incor.usp.br
mass{at}incor.usp.br

OBJECTIVES: We sought to evaluate the relative efficacies of three possible therapeutic strategies for patients with multivessel coronary artery disease (CAD), stable angina, and preserved ventricular function.

BACKGROUND: Despite routine use of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI), there is no conclusive evidence that either one is superior to medical therapy (MT) alone for the treatment of multivessel CAD.

METHODS: The primary end point was defined as cardiac mortality, Q-wave myocardial infarction (MI), or refractory angina requiring revascularization. All data were analyzed according to the intention-to-treat principle.

RESULTS: A total of 611 patients were randomly assigned to either a CABG (n = 203), PCI (n = 205), or MT (n = 203) group. The one-year survival rates were 96.0% for CABG, 95.6% for PCI, and 98.5% for MT. The rates for one-year survival free of Q-wave MI were 98% for CABG, 92% for PCI, and 97% for MT. After one-year follow-up, 8.3% of MT patients and 13.3% of PCI patients underwent to additional interventions, compared with only 0.5% of CABG patients. At one-year follow-up, 88% of the patients in the CABG group, 79% in the PCI group, and 46% in the MT group were free of angina (p < 0.0001).

CONCLUSIONS: Medical therapy for multivessel CAD was associated with a lower incidence of short-term events and a reduced need for additional revascularization, compared with PCI. In addition, CABG was superior to MT for eliminating anginal symptoms. All three therapeutic regimens yielded relatively low rates of cardiac-related deaths.

Abbreviations and Acronyms
  CABG = coronary artery bypass graft surgery
  CAD = coronary artery disease
  CCS = Canadian Cardiovascular Society
  ECG = electrocardiogram/electrocardiographic
  MASS-II = Medicine, Angioplasty, or Surgery Study-II
  MI = myocardial infarction
  MT = medical therapy
  PCI = percutaneous coronary intervention




This article has been cited by other articles:


Home page
J Am Coll CardiolHome page
A. Schomig, J. Mehilli, A. de Waha, M. Seyfarth, J. Pache, and A. Kastrati
A Meta-Analysis of 17 Randomized Trials of a Percutaneous Coronary Intervention-Based Strategy in Patients With Stable Coronary Artery Disease
J. Am. Coll. Cardiol., September 9, 2008; 52(11): 894 - 904.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
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]


Home page
CirculationHome page
J. Booth, T. Clayton, J. Pepper, F. Nugara, M. Flather, U. Sigwart, R. H. Stables, and on Behalf of the SoS Investigators
Randomized, Controlled Trial of Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease: Six-Year Follow-Up From the Stent or Surgery Trial (SoS)
Circulation, July 22, 2008; 118(4): 381 - 388.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll Cardiol ImgHome page
V. Cheng, A. Gutstein, A. Wolak, Y. Suzuki, D. Dey, H. Gransar, L. E.J. Thomson, S. W. Hayes, J. D. Friedman, and D. S. Berman
Moving Beyond Binary Grading of Coronary Arterial Stenoses on Coronary Computed Tomographic Angiography: Insights for the Imager and Referring Clinician
J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 460 - 471.
[Abstract] [Full Text] [PDF]


Home page
Eur. J. Cardiothorac. Surg.Home page
N. H. Lopes, F. d. S. Paulitsch, A. F. Gois, A. C. Pereira, N. A. Stolf, L. O. Dallan, J. A.F. Ramires, and W. A. Hueb
Impact of number of vessels disease on outcome of patients with stable coronary artery disease: 5-year follow-up of the Medical, Angioplasty, and bypass Surgery Study (MASS)
Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 349 - 354.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll Cardiol IntvHome page
D. R. Holmes Jr, B. J. Gersh, P. Whitlow, S. B. King III, and J. T. Dove
Percutaneous Coronary Intervention for Chronic Stable Angina: A Reassessment
J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 34 - 43.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
J. H. Yang, H.-C. Gwon, S. J. Cho, J. Y. Hahn, J.-H. Choi, S. H. Choi, Y. T. Lee, S. H. Lee, K. P. Hong, and J. E. Park
Comparison of Coronary Artery Bypass Grafting With Drug-Eluting Stent Implantation for the Treatment of Multivessel Coronary Artery Disease
Ann. Thorac. Surg., January 1, 2008; 85(1): 65 - 70.
[Abstract] [Full Text] [PDF]


Home page
Card Surg AdultHome page
M. L. Brown, T. M. Sundt III, and B. J. Gersh
Indications for Revascularization
Card. Surg. Adult, January 1, 2008; 3(2008): 551 - 572.
[Full Text]


Home page
NEJMHome page
S. Cheng and J. Jarcho
Management of Stable Coronary Disease -- Polling Results
N. Engl. J. Med., December 13, 2007; 357(24): e28 - e28.
[Full Text] [PDF]


Home page
ANN INTERN MEDHome page
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]


Home page
J Am Coll CardiolHome page
G. A. Diamond and S. Kaul
COURAGE Under Fire: On the Management of Stable Coronary Disease
J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1604 - 1609.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
A. Javaid, D. H. Steinberg, A. N. Buch, P. J. Corso, S. W. Boyce, T. L. Pinto Slottow, P. K. Roy, P. Hill, T. Okabe, R. Torguson, et al.
Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention With Drug-Eluting Stents for Patients With Multivessel Coronary Artery Disease
Circulation, September 11, 2007; 116(11_suppl): I-200 - I-206.
[Abstract] [Full Text] [PDF]


Home page
Canadian J. AnesthesiaHome page
E. Y.W. Wong, H. P. Lawrence, and D. T. Wong
The effects of prophylactic coronary revascularization or medical management on patient outcomes after noncardiac surgery - a meta-analysis: [Les effets de la revascularisation coronarienne prophylactique ou de la prise en charge medicale sur le devenir des patients apres une chirurgie non-cardiaque : une meta-analyse]
Can J Anesth, September 1, 2007; 54(9): 705 - 717.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
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]


Home page
Asian Cardiovasc. Thorac. Ann.Home page
S. H Wong, S. Wan, and M. J Underwood
Myocardial Revascularization: Surgery or Stenting?
Asian Cardiovasc Thorac Ann, June 1, 2007; 15(3): 264 - 269.
[Abstract] [Full Text] [PDF]


Home page
NEJMHome page
W. E. Boden, R. A. O'Rourke, K. K. Teo, P. M. Hartigan, D. J. Maron, W. J. Kostuk, M. Knudtson, M. Dada, P. Casperson, C. L. Harris, et al.
Optimal Medical Therapy with or without PCI for Stable Coronary Disease
N. Engl. J. Med., April 12, 2007; 356(15): 1503 - 1516.
[Abstract] [Full Text] [PDF]


Home page
BMJHome page
S C Griffin, J A Barber, A Manca, M J Sculpher, S G Thompson, M J Buxton, and H Hemingway
Cost effectiveness of clinically appropriate decisions on alternative treatments for angina pectoris: prospective observational study
BMJ, March 24, 2007; 334(7594): 624 - 624.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
W. Hueb, N. H. Lopes, B. J. Gersh, P. Soares, L. A.C. Machado, F. B. Jatene, S. A. Oliveira, and J. A.F. Ramires
Five-Year Follow-Up of the Medicine, Angioplasty, or Surgery Study (MASS II): A Randomized Controlled Clinical Trial of 3 Therapeutic Strategies for Multivessel Coronary Artery Disease
Circulation, March 6, 2007; 115(9): 1082 - 1089.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
W. Hueb, B. J. Gersh, F. Costa, N. Lopes, P. R. Soares, P. Dutra, F. Jatene, A. C. Pereira, A. F.T. Gois, S. A. Oliveira, et al.
Impact of Diabetes on Five-Year Outcomes of Patients With Multivessel Coronary Artery Disease
Ann. Thorac. Surg., January 1, 2007; 83(1): 93 - 99.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
J. J. Mahmarian, H. A. Dakik, N. G. Filipchuk, L. J. Shaw, S. S. Iskander, T. D. Ruddy, F. Keng, M. J. Henzlova, A. Allam, L. A. Moye, et al.
An Initial Strategy of Intensive Medical Therapy Is Comparable to That of Coronary Revascularization for Suppression of Scintigraphic Ischemia in High-Risk But Stable Survivors of Acute Myocardial Infarction
J. Am. Coll. Cardiol., December 19, 2006; 48(12): 2458 - 2467.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
K. L. Gould
Physiological severity of coronary artery stenosis
Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2583 - H2585.
[Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
P. K. Smith, R. M. Califf, R. H. Tuttle, L. K. Shaw, K. L. Lee, E. R. Delong, R. E. Lilly, M. H. Sketch Jr, E. D. Peterson, and R. H. Jones
Selection of surgical or percutaneous coronary intervention provides differential longevity benefit.
Ann. Thorac. Surg., October 1, 2006; 82(4): 1420 - 1429.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
A. C. Pereira, N. H.M. Lopes, P. R. Soares, J. E. Krieger, S. A. de Oliveira, L. A.M. Cesar, J. A.F. Ramires, and W. Hueb
Clinical Judgment and Treatment Options in Stable Multivessel Coronary Artery Disease: Results From the One-Year Follow-Up of the MASS II (Medicine, Angioplasty, or Surgery Study II)
J. Am. Coll. Cardiol., September 5, 2006; 48(5): 948 - 953.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
O. Ben-Yehuda
Physician Judgment in Cardiology: The Art of Medicine Lives On
J. Am. Coll. Cardiol., September 5, 2006; 48(5): 954 - 955.
[Full Text] [PDF]


Home page
Eur. J. Cardiothorac. Surg.Home page
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]


Home page
CirculationHome page
P. R. Soares, W. A. Hueb, P. A. Lemos, N. Lopes, E. E. Martinez, L. A.M. Cesar, S. A. Oliveira, and J. A.F. Ramires
Coronary Revascularization (Surgical or Percutaneous) Decreases Mortality After the First Year in Diabetic Subjects but not in Nondiabetic Subjects With Multivessel Disease: An Analysis From the Medicine, Angioplasty, or Surgery Study (MASS II)
Circulation, July 4, 2006; 114(1_suppl): I-420 - I-424.
[Abstract] [Full Text] [PDF]


Home page
JAMAHome page
Additional Information
JAMA, March 15, 2006; 295(11): E1 - E6.
[Full Text] [PDF]


Home page
Eur Heart JHome page
M. Hordijk-Trion, M. Lenzen, W. Wijns, P. de Jaegere, M. L. Simoons, W. J.M. Scholte op Reimer, M. E. Bertrand, N. Mercado, E. Boersma, and on behalf of the EHS-CR Investigators
Patients enrolled in coronary intervention trials are not representative of patients in clinical practice: results from the Euro Heart Survey on Coronary Revascularization
Eur. Heart J., March 2, 2006; 27(6): 671 - 678.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, A. K. Jacobs, M. J. Kern, S. B. King III, D. A. Morrison, W. W. O'Neill, H. V. Schaff, P. L. Whitlow, et al.
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)
J. Am. Coll. Cardiol., January 3, 2006; 47(1): 216 - 235.
[Full Text] [PDF]


Home page
CirculationHome page
S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, A. K. Jacobs, M. J. Kern, S. B. King III, D. A. Morrison, W. W. O'Neill, H. V. Schaff, P. L. Whitlow, et al.
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)
Circulation, January 3, 2006; 113(1): 156 - 175.
[Full Text] [PDF]


Home page
CirculationHome page
H. Thiele, S. Oettel, S. Jacobs, R. Hambrecht, P. Sick, J. F. Gummert, F. W. Mohr, G. Schuler, and V. Falk
Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery: A 5-Year Follow-Up
Circulation, November 29, 2005; 112(22): 3445 - 3450.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
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]


Home page
J Am Coll CardiolHome page
A. E. Rodriguez, J. Baldi, C. F. Pereira, J. Navia, M. R. Alemparte, A. Delacasa, F. Vigo, D. Vogel, W. O'Neill, I. F. Palacios, et al.
Five-Year Follow-Up of the Argentine Randomized Trial of Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease (ERACI II)
J. Am. Coll. Cardiol., August 16, 2005; 46(4): 582 - 588.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
N. Mercado, W. Wijns, P. W. Serruys, U. Sigwart, M. D. Flather, R. H. Stables, W. W. O'Neill, A. Rodriguez, P. A. Lemos, W. A. Hueb, et al.
One-year outcomes of coronary artery bypass graft surgery versus percutaneous coronary intervention with multiple stenting for multisystem disease: A meta-analysis of individual patient data from randomized clinical trials
J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 512 - 519.
[Abstract] [Full Text] [PDF]


Home page
NEJMHome page
J. Abrams
Chronic Stable Angina
N. Engl. J. Med., June 16, 2005; 352(24): 2524 - 2533.
[Full Text] [PDF]


Home page
CirculationHome page
D. G. Katritsis and J. P.A. Ioannidis
Percutaneous Coronary Intervention Versus Conservative Therapy in Nonacute Coronary Artery Disease: A Meta-Analysis
Circulation, June 7, 2005; 111(22): 2906 - 2912.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
R. H. Jones
The Year in Cardiovascular Surgery
J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1517 - 1528.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
W. W. O'Neill, S. R. Dixon, and C. L. Grines
The year in interventional cardiology
J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1117 - 1134.
[Full Text] [PDF]


Home page
CMAJHome page
J. M. Brophy
The dollars and sense of drug-eluting stents
Can. Med. Assoc. J., February 1, 2005; 172(3): 361 - 362.
[Full Text] [PDF]


Home page
Evid. Based Med.Home page
ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB
Evid. Based Med., November 1, 2004; 9(6): 163 - 163.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
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]




HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 2004 by the American College of Cardiology Foundation.