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


     

J Am Coll Cardiol, 2007; 49:1600-1606, doi:10.1016/j.jacc.2006.11.048 (Published online 30 March 2007).
© 2007 by the American College of Cardiology Foundation
This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
j.jacc.2006.11.048v1
49/15/1600    most recent
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 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 Search for Related Content

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


   Abstract
Top
 Abstract
Methods
 Results
 Discussion
 Appendix
 References
 
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.

Abbreviations and Acronyms
  CABG = coronary artery bypass grafting
  CAD = coronary artery disease
  MI = myocardial infarction
  PTCA = percutaneous transluminal coronary balloon angioplasty

The BARI (Bypass Angioplasty Revascularization Investigation) randomized trial was designed to test whether percutaneous transluminal coronary balloon angioplasty (PTCA) compromised 5-year survival compared with coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease (CAD). After 5 years of follow-up, overall survival was similar for the 2 revascularization strategies (1); however, after 7 years of follow-up, CABG survival was statistically superior (2).

An unexpected finding of the BARI trial was that among patients without treated diabetes, survival rates for the PTCA and CABG randomized groups were almost identical throughout the 7 years of follow-up, whereas among patients with treated diabetes, the CABG group had significantly better survival. The survival difference was attributable to reduced cardiac mortality (3).

This report describes the final 10-year results from the BARI randomized trial for the entire study group as well as for subgroups defined by treated diabetes status.


   Methods
Top
 Abstract
 Methods
Results
 Discussion
 Appendix
 References
 
The BARI trial enrolled patients with angiographically documented multivessel CAD and severe angina or objective evidence of ischemia requiring revascularization, as described previously (1,2). Between 1988 and 1991, BARI randomized 1,829 patients at 18 North American sites to receive initial revascularization with either CABG or PTCA.

The vital status of each patient was ascertained on March 31, 2000; patients who had not completed 10 years of follow-up by that date were followed up until they reached their 10-year visit. The BARI study ceased following up patients in 2002.

The primary end point was all-cause mortality, and secondary end points included death of cardiac cause, the composite end point of death or Q-wave myocardial infarction (MI), the composite end point of death of cardiac cause or any MI (Q-wave or non–Q-wave), subsequent revascularization procedures, and anginal status. All MI events were classified by the BARI central laboratory (St. Louis University) based on serial electrocardiographic analysis regardless of symptoms (4). The cause of death was classified by an independent review committee.

A priori subgroups specified by the BARI protocol included anginal status, number of diseased vessels, proximal left anterior descending coronary artery disease, left ventricular function, and lesion complexity. The BARI central radiographic laboratory (Stanford University) interpreted baseline coronary angiograms (5). Based on a request from the study Data and Safety Monitoring Board in 1992, patients were classified by treated diabetes status defined as treatment with either oral hypoglycemic medication or insulin at study entry.

Statistical methods.   Kaplan-Meier estimates and log rank tests were used to compare death, cardiac events, and subsequent revascularization rates according to the intention-to-treat principle. The mean restricted life expectancy was estimated by the area under the survival curve between 0 and 10 years. The significance of statistical interactions between randomized treatment and subgroup variables were assessed with Cox regression. Generalized estimation equations were used to analyze presence of angina over time, and Nelson-Aalen methods were used to estimate the number of subsequent procedures. A value of p < 0.05 was considered statistically significant except for the treatment comparisons within identified subgroups, in which p < 0.01 was used to control for multiple comparisons.


   Results
Top
 Abstract
 Methods
 Results
Discussion
 Appendix
 References
 
Baseline characteristics of CABG and PTCA groups were similar (Table 1). The average follow-up was 10.4 years.


View this table:
[in this window]
[in a new window]

  		Table 1 BARI Randomized Trial Baseline Characteristics by Assigned Treatment and by Treated Diabetes Status
 
Freedom from mortality and MI.   At 10 years, mortality and MI event rates were not statistically different between randomized treatment groups (Table 2, Figs. 1 and 2).Go The mean restricted life expectancy after study enrollment was 8.86 years for CABG-assigned patients and 8.63 years for PTCA-assigned patients.


View this table:
[in this window]
[in a new window]

  		Table 2 Estimated 5- and 10-Year Survival for BARI Randomized Patients by Assigned Treatment and by Treated Diabetes Status
 

Figure 1
View larger version (16K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1 Overall Survival and Survival Free of Q-Wave MI by Randomized Treatment

The blue solid lines indicate coronary artery bypass grafting (CABG), and percutaneous transluminal coronary balloon angioplasty (PTCA) by red dashed lines. MI = myocardial infarction.

 

Figure 2
View larger version (19K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2 Freedom From Cardiac Death and Freedom From Cardiac Death or Any MI by Randomized Treatment

The blue solid lines indicate CABG, and PTCA by red dashed lines. Abbreviations as in Figure 1.

 
Based on 10-year survival, there were no statistically significant interactions between treatment and the subgroup variables analyzed (Fig. 3). Clinical outcomes were influenced by treated diabetes status (Table 2, Fig. 4). Among patients without treated diabetes, survival was comparable for the randomized treatment groups throughout the 10 years of follow-up. In the treated diabetes subgroup, patients assigned to CABG had significantly higher cardiac survival (p < 0.01) and trends for better survival and greater freedom from cardiac death or any MI (p < 0.05); note that the interaction between diabetes and treatment for freedom from cardiac death was significant (p = 0.032). The mean restricted life expectancy was 9.05 years for CABG-assigned patients and 9.02 years for PTCA-assigned patients without treated diabetes and 8.07 years for CABG-assigned patients and 6.93 years for PTCA-assigned patients with treated diabetes.


Figure 3
View larger version (15K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 3 10-Year Survival Rates for Patients According to Subgroups Based on Characteristics at Study Entry

Ninety-nine percent confidence intervals of the absolute treatment difference between 10-year survival rates are shown for each subgroup. The test of the interaction between treatment effect and subgroup is based on proportional hazards models. CABG = coronary artery bypass grafting; CCS = Canadian Cardiovascular Society classification of angina; CHF = congestive heart failure; ECG = electrocardiogram; LAD = left anterior descending coronary artery; LV = left ventricular; MI = myocardial infarction; PTCA = percutaneous transluminal coronary balloon angioplasty; PVD = peripheral vascular disease.

 

Figure 4
View larger version (21K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4 Overall Survival by Randomized Treatment Stratified by Diabetes Status

Patients who were being treated for diabetes at baseline are shown with heavy lines, and all other patients are shown with light lines. The blue solid lines indicate CABG, and the red dashed lines indicate PTCA. D = treated diabetes; ND = no treated diabetes; other abbreviations as in Figure 1.

 
Among patients with treated diabetes who received their assigned revascularization procedure, CABG patients receiving at least 1 arterial graft (n = 145) had 64.3% 10-year survival, compared with 39.4% in CABG patients receiving only vein grafts (n = 33) and 45.5% in PTCA patients (n = 63). Among patients without treated diabetes, there was no difference in 10-year survival between CABG patients with an arterial graft (n = 602, 75.3%) and those with only vein grafts (n = 134, 77.8%).

Repeat revascularization.   A significantly smaller proportion of patients assigned to CABG received subsequent revascularization (Table 3), and they had substantially fewer revascularization procedures over the 10 years of follow-up (Fig. 5).


View this table:
[in this window]
[in a new window]

  		Table 3 Estimated Cumulative Rates of Subsequent Revascularization Procedures* at 10 Years by Assigned Treatment and by Treated Diabetes Status
 

Figure 5
View larger version (14K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 5 Cumulative Number of Subsequent Revascularization Procedures per 100 Patients by Randomization

The blue solid lines indicate CABG, and the red dashed lines indicate PTCA. Abbreviations as in Figure 1.

 
Angina.   At 10 years, the prevalence of angina was similar in the randomized treatment groups (Fig. 6). At 6 months, angina was less frequent in CABG patients, but the odds of having angina increased 8% per year for CABG patients (p < 0.001) and decreased 6% per year for PTCA patients (p < 0.001). Among surviving patients without diabetes, 10-year angina rates were 15.0% for each treatment group, and among those with diabetes, rates were 25.7% in the PTCA group and 23.1% in the CABG group.


Figure 6
View larger version (34K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6 Percent of Surviving Patients With Stable or Unstable Angina at Each Follow-Up by Randomization

The blue diagonally-striped bars indicate CABG, and the red horizontally-dashed bars indicate PTCA. Abbreviations as in Figure 1.

 
Medications.   A majority of patients received beta-blockers, calcium antagonists, or long-acting nitrates (75% PTCA and 66% CABG at 8 years) and antiplatelet therapy, almost entirely aspirin (84% PTCA and 86% CABG at 8 years). Rates of lipid-lowering therapy increased steadily from 29% PTCA and 21% CABG at 1 year to 65% PTCA and 63% CABG by 10 years.


   Discussion
Top
 Abstract
 Methods
 Results
 Discussion
Appendix
 References
 
The long-term follow-up of this large cohort of selected patients with multivessel CAD randomized to receive either balloon angioplasty or coronary bypass surgery shows similar rates of survival and freedom from MI over 10 years. The initial cardiac revascularization procedures in BARI were performed between 1988 and 1991, before the introduction of coronary stents and other technical refinements in angioplasty and surgery. Although some might argue that these procedural refinements make the results of the BARI trial obsolete, we believe that our observations with respect to death and MI remain applicable to contemporary practice. Overviews of the randomized trials of bare metal stents (6,7) and drug-eluting stents (8,9) show that these devices have no significant advantage regarding mortality or MI compared with balloon angioplasty despite striking reductions in rates of restenosis and repeat revascularization procedures. Furthermore, observational studies of patients undergoing angioplasty indicate that restenosis does not confer a worse prognosis concerning survival (10).

A comprehensive review of trials and registries comparing percutaneous coronary intervention with CABG is presented elsewhere (11). The BARI trial results are consistent with those of recent clinical trials such as ARTS (Arterial Revascularization Therapies Study) (12), which reported comparable 5-year mortality for coronary bare-metal stenting and CABG (8.0% stents vs. 7.6% CABG), but more subsequent revascularization (30.3% vs. 8.8%) and more angina (21.2% vs. 15.5%) in the stenting group. Meta-analyses (13) and registries (14) based on larger and more diverse populations have shown small but statistically significant survival advantages with CABG at 3 to 5 years. In the New York cardiac registry, 37,212 multivessel CAD patients undergoing CABG had better risk-adjusted survival than 22,102 undergoing stenting (14). Given the observed 10-year mortality rate in BARI, more than 7,200 patients would be required to have sufficient power to detect a 3% absolute difference in mortality, thus reflecting the challenge of conducting clinical trials.

In patients with type 2 diabetes, CABG conferred a consistent, clinically relevant, absolute survival benefit over balloon angioplasty that diminished somewhat over extended follow-up because patients in both groups had higher event rates. Five-year mortality results from ARTS (diabetes: 13.4% stents vs. 8.3% CABG, relative risk = 1.61, p = 0.27; no diabetes: 6.8% stents vs. 7.5% CABG, relative risk = 0.91, p = 0.71) (15) support the finding that CABG may have particular advantages for patients with diabetes. It remains to be seen whether advances in percutaneous procedures and medical management over the past decade will make contemporary angioplasty a reasonable option in this cohort.

The steady incidence of cardiac events over the 10 years of follow-up in both treatment groups emphasizes that coronary revascularization does not reverse the underlying pathophysiology of coronary disease. Underuse of evidence-based medical therapies is unfortunately common among patients with coronary disease. Clinical outcomes for all patients may be improved further by providing long-term aggressive medical management after revascularization.


   Appendix
Top
 Abstract
 Methods
 Results
 Discussion
 Appendix
References
 
A complete list of the BARI Investigators is published in reference 3.

This article was prepared by: Maria Mori Brooks, PhD, Edwin L. Alderman, MD, Eric Bates, MD, Martial Bourassa, MD, Robert M. Califf, MD, Bernard R. Chaitman, MD, Katherine M. Detre, MD, DrPH, Frederick Feit, MD, Robert L. Frye, MD, Raymond J. Gibbons, MD, Regina M. Hardison, MS, Mark A. Hlatky, MD, David R. Holmes, Jr., MD, Alice K. Jacobs, MD, Sheryl F. Kelsey, PhD, Mary Krauland, BS, William J. Rogers, MD, Hartzell V. Schaff, MD, Leonard Schwartz, MD, Kim Sutton-Tyrrell, DrPH, David O. Williams, MD, Patrick K. Whitlow, MD. Dr. Frye, as study chairman, assumes responsibility for overall content and integrity of this article.

From the University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania (M.M.B., K.M.D., R.M.H., S.F.K., M.K., K.S.-T.); Stanford University Medical Center, Stanford, California (E.L.A., M.A.H.); University of Michigan, Ann Arbor, Michigan (E.B.); Montreal Heart Institute, Montreal, Canada (M.B.); Duke University Medical Center, Durham, North Carolina (R.M.C.); St. Louis University Medical Center, St. Louis, Missouri (B.R.C.); New York University School of Medicine, New York, New York (F.R.); Mayo Clinic, Rochester, Minnesota (R.L.F., R.J.G., D.R.H., H.V.S.); Boston University Medical Center, Boston, Massachusetts (A.K.J.); University of Alabama at Birmingham, Birmingham, Alabama (W.J.R.); Toronto General Hospital, Toronto, Canada (L.S.); Brown University, Rhode Island Hospital, Providence, Rhode Island (D.O.W.); and the Cleveland Clinic Foundation, Cleveland, Ohio (P.L.W.).


   Acknowledgments
 
The entire BARI team acknowledges the unfortunate death of our esteemed colleague and friend Dr. Katherine Detre. This analysis of the 10-year results of the original BARI trial is dedicated to her. Dr. Detre led the BARI investigation with distinction and a commitment to enhance the care of patients by way of rigorous analysis of clinical evidence.


   Footnotes
 
This study was supported by the following National Heart, Lung, and Blood Institute grants: HL38493, HL38504, HL38509, HL38512, HL38514-6, HL38518, HL38524-5, HL38529, HL38532, HL38556, HL38610, HL38642, and HL42145.

* Please see the Appendix for a full list of the BARI Investigators. Back


   References
Top
 Abstract
 Methods
 Results
 Discussion
 Appendix
 References
 

  1. The BARI Investigators Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease N Engl J Med 1996;335:217-225.[Abstract/Free Full Text]
  2. The BARI Investigators Seven-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI) by treatment and diabetic status J Am Coll Cardiol 2000;35:1122-1129.[Abstract/Free Full Text]
  3. The BARI Investigators Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing PTCA and CABG in patients with multivessel diseaseThe Bypass Angioplasty Revascularization Investigation (BARI). Circulation 1997;96:1761-1769.[Abstract/Free Full Text]
  4. Chaitman BR, Rosen AD, Williams DO, et al. Myocardial infarction and cardiac mortality in the Bypass Angioplasty Revascularization Investigation (BARI) randomized trial Circulation 1997;96:2162-2170.[Abstract/Free Full Text]
  5. Alderman EL, Stadius M. The angiographic definitions of the Bypass Angioplasty Revascularization Investigation Coron Artery Dis 1992;3:1189-1207.[ISI]
  6. Brophy JM, Belisle P, Joseph L. Evidence for use of coronary stentsA hierarchical Bayesian meta-analysis. Ann Intern Med 2003;138:777-786.[Abstract/Free Full Text]
  7. Kandzari DE, Tuttle RH, Zidar JP, Jollis JG. Comparison of long-term (seven year) outcomes among patients undergoing percutaneous coronary revascularization with versus without stenting Am J Cardiol 2006;97:1467-1472.[CrossRef][ISI][Medline]
  8. Babapulle MN, Joseph L, Belisle P, et al. A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents Lancet 2004;364:583-591.[CrossRef][ISI][Medline]
  9. Tsimikas S. Drug-eluting stents and late adverse clinical outcomes: lessons learned, lessons awaited J Am Coll Cardiol 2006;47:2112-2115.[Free Full Text]
  10. Weintraub WS, Ghazzal ZM, Douglas JS, et al. Long-term clinical follow-up in patients with angiographic restudy after successful angioplasty Circulation 1993;87:831-840.[Abstract/Free Full Text]
  11. King SB. Coronary artery bypass graft versus percutaneous coronary intervention: status of trials J Interv Cardiol 2006;19:S3-S7.
  12. Serruys PW, Ong ATL, van Herwerden LA, et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease J Am Coll Cardiol 2005;46:575-581.[Abstract/Free Full Text]
  13. Hoffman SN, TenBrook JA, Wolf MP, et al. A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one to eight year outcomes J Am Coll Cardiol 2003;41:1293-1304.[Abstract/Free Full Text]
  14. Hannan El, Racz MJ, Walford G, et al. Long-term outcomes of coronary bypass grafting versus stent implantation N Engl J Med 2005;352:2174-2183.[Abstract/Free Full Text]
  15. Abizaid A, Costa MA, Centemero M, et al. Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients: insights from the Arterial Revascularization Therapy Study (ARTS) trial Circulation 2001;104:533-538.[Abstract/Free Full Text]



This article has been cited by other articles:


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 CardiolHome page
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The year in interventional cardiology.
J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369.
[Full Text] [PDF]

Home page
 J Am Coll Cardiol ImgHome page
J. T. Ortiz-Perez, J. Rodriguez, S. N. Meyers, D. C. Lee, C. Davidson, and E. Wu
Correspondence Between the 17-Segment Model and Coronary Arterial Anatomy Using Contrast-Enhanced Cardiac Magnetic Resonance Imaging
J. Am. Coll. Cardiol. Img., May 1, 2008; 1(3): 282 - 293.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. H. Jones
The Year in Cardiovascular Surgery
J. Am. Coll. Cardiol., April 29, 2008; 51(17): 1707 - 1718.
[Full Text] [PDF]

Home page
 CirculationHome page
D.-W. Park, S.-C. Yun, S.-W. Lee, Y.-H. Kim, C. W. Lee, M.-K. Hong, J.-J. Kim, S. J. Choo, H. Song, C. H. Chung, et al.
Long-Term Mortality After Percutaneous Coronary Intervention With Drug-Eluting Stent Implantation Versus Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Artery Disease
Circulation, April 22, 2008; 117(16): 2079 - 2086.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
J. Brinker
The left main facts: faced, spun, but alas too few.
J. Am. Coll. Cardiol., March 4, 2008; 51(9): 893 - 898.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
M. D. Kertai
Preoperative Coronary Revascularization in High-Risk Patients Undergoing Vascular Surgery: A Core Review
Anesth. Analg., March 1, 2008; 106(3): 751 - 758.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Ohno, S. Takamoto, and N. Motomura
Diabetic Retinopathy and Coronary Artery Disease From the Cardiac Surgeon's Perspective
Ann. Thorac. Surg., February 1, 2008; 85(2): 681 - 689.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
N. D. Desai
Pitfalls Assessing the Role of Drug-Eluting Stents in Multivessel Coronary Disease
Ann. Thorac. Surg., January 1, 2008; 85(1): 25 - 27.
[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
 J Am Coll CardiolHome page
D. J. Kereiakes, P. S. Teirstein, I. J. Sarembock, D. R. Holmes Jr, M. W. Krucoff, W. W. O'Neill, R. Waksman, D. O. Williams, J. J. Popma, M. Buchbinder, et al.
The Truth and Consequences of the COURAGE Trial
J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1598 - 1603.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
j.jacc.2006.11.048v1
49/15/1600    most recent
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 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 Search for Related Content

HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK