Native coronary disease progression exceeds failed revascularization as cause of angina after five years in the bypass angioplasty revascularization investigation (BARI)
Edwin L. Alderman, MD, FACC,*,*,
Kevin E. Kip, PhD, ,
Patrick L. Whitlow, MD, FACC, ,
Thomas Bashore, MD, FACC, ,
Donald Fortin, MD,,
Martial G. Bourassa, MD, FACC,||,
Jacques Lesperance, MD,||,
Leonard Schwartz, MD, FACC,¶ and
Michael Stadius, MD, FACC#
* Cardiovascular Division, Stanford University, Stanford, California
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Cleveland Clinic, Cleveland, Ohio
Cardiology Division, Duke University, Durham, North Carolina
|| Montreal Heart Institute, Montreal, Canada
¶ Toronto General Hospital, Toronto, Canada
# University of Washington, Seattle, Washington
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Figure 1 The coronary artery map used by Bypass Angioplasty Revascularization Investigations (BARI and BARI2D) is the basis for relative artery sizing, stenosis placement, and estimation of myocardial jeopardy. The map is a modification of the Coronary Artery Surgery Study (CASS) diagram with inclusion of additional branch segments.
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Figure 2 (A) The distribution of myocardial jeopardy scores at baseline, one-year, and five-year angiography among the subset of 183 patients with all three assessments. The center block on each vertical line depicts the mean myocardial jeopardy; the horizontal hash marks at each end of the vertical line represent myocardial jeopardy scores at ± 1 SD from the mean. The "n's" for the percutaneous coronary intervention (PCI) group reflect not having undergone prior coronary artery bypass graft surgery (CABG) at each follow-up assessment. (B) Histogram of the percentage of patients with angina at baseline, one-year, and five-year angiography by assigned mode of initial revascularization (CABG or PCI).
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Figure 3 Percentage of patients with increased jeopardized myocardium at five years, including cause of increased jeopardy and assigned mode of initial revascularization. Some patients have multiple causes of increased myocardial jeopardy, and thus are included in multiple categories. Open bars = percutaneous coronary intervention patients (202); solid bars = coronary artery bypass graft surgery patients (200). *Defined as increased jeopardy that occurs after initial revascularization and is not mitigated by subsequent revascularization procedures.
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Figure 4 Among patients with new or progressive disease evident at five years, histogram shows the percentage of all patients who experienced increased myocardial jeopardy attributable to vessels treated and/or untreated at the initial revascularization procedure. Open bars = percutaneous coronary intervention patients (76); solid bars = coronary artery bypass graft surgery patients (82).
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