MYOCARDIAL-INFARCTION AND CARDIAC MORTALITY IN THE BYPASS ANGIOPLASTYREVASCULARIZATION INVESTIGATION (BARI) RANDOMIZED TRIAL

Background Cardiac mortality and myocardial infarction (MI) rates are used to evaluate the efficacy of coronary artery bypass grafting (CABG ) and percutaneous transluminal coronary angioplasty (PTCA). We compar ed 5-year cardiac mortality and MI rates in 1829 patients with multive ssel disease randomized to CABG or PTCA. Methods and Results The 5-yea r cardiac mortality rate was 8.0% in patients assigned to PTCA compare d with 4.9% in those assigned to CABG (relative risk [RR] of 1.55 with a 95% confidence interval [CI] of 1.07 to 2.23; P = .022). In a subgr oup of 1476 nondiabetic patients, there were no significant difference s between treatment groups in cardiac mortality either overall (4.6% v ersus 4.2%; RR = 1.04, 95% CI, 0.65 to 1.66; P = .908) or in subgroups based on symptoms, left ventricular function, number of diseased vess els, or stenotic proximal left anterior descending artery. The two tre atment groups had similar event rates for the combined end point of ca rdiac death or MI. The RR for cardiac mortality in 264 patients who su stained an MI compared with those who did not was 5.9 (P < .001). Mrs were more common after CABG during index hospitalization (P = .004), b ut in the PTCA group, they were more common after discharge (P < .001) . Conclusions The Bypass Angioplasty Revascularization Investigation ( BARI) trial indicates 5-year cardiac mortality in patients with multiv essel disease was significantly greater after initial treatment with P TCA than with CABG. The difference was manifest in diabetic patients o n drug therapy. There were no significant differences overall for the composite end point of cardiac mortality or MI between treatment group s or for cardiac mortality in nondiabetic patients regardless of sympt oms, left ventricular function, number of diseased vessels, or stenoti c proximal left anterior descending artery.