CLINICAL RESEARCH: CLINICAL TRIAL
The Final 10-Year Follow-Up Results From the BARI Randomized Trial
The BARI Investigators*
Manuscript received August 11, 2006;
revised manuscript received November 20, 2006,
accepted November 21, 2006.
* Reprint requests and correspondence: Dr. Maria Mori Brooks, The University of Pittsburgh, Graduate School of Public Health, 127 Parran Hall/130 DeSoto Street, Pittsburgh, Pennsylvania 15261. E-mail: mbrooks@pitt.edu
Objectives: We sought to compare 10-year clinical outcomes in the BARI (Bypass Angioplasty Revascularization Investigation) trial patients who were randomly assigned to percutaneous transluminal coronary balloon angioplasty (PTCA) versus coronary artery bypass grafting (CABG).
Background: Angioplasty and bypass surgery have been compared in numerous studies, but long-term clinical outcomes are limited.
Methods: Symptomatic patients with multivessel coronary artery disease (n = 1,829) were randomly assigned to initial treatment with PTCA or CABG and followed up for an average of 10.4 years. Analyses were conducted on an intention-to-treat basis.
Results: The 10-year survival was 71.0% for PTCA and 73.5% for CABG (p = 0.18). At 10 years, the PTCA group had substantially higher subsequent revascularization rates than the CABG group (76.8% vs. 20.3%, p < 0.001), but angina rates for the 2 groups were similar. In the subgroup of patients with no treated diabetes, survival rates were nearly identical by randomization (PTCA 77.0% vs. CABG 77.3%, p = 0.59). In the subgroup with treated diabetes, the CABG assigned group had higher survival than the PTCA assigned group (PTCA 45.5% vs. CABG 57.8%, p = 0.025).
Conclusions: There was no significant long-term disadvantage regarding mortality or myocardial infarction associated with an initial strategy of PTCA compared with CABG. Among patients with treated diabetes, CABG conferred long-term survival benefit, whereas the 2 initial strategies were equivalent regarding survival for patients without diabetes.
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Abbreviations and Acronyms
| | CABG = coronary artery bypass grafting | | CAD = coronary artery disease | | MI = myocardial infarction | | PTCA = percutaneous transluminal coronary balloon angioplasty |
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