ANGIOGRAPHIC CORRELATES OF LESION RELEVANCE AND SUITABILITY FOR PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY AND CORONARY-ARTERY BYPASS-GRAFTING IN THE BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION STUDY (BARI)

The Bypass Angioplasty Revascularization Investigation (BARI) randomiz ed 1,829 patients to percutoneous transluminal coronary angioplasty (P TCA) or coronary artery bypass grafting (CABG). Clinical site angiogra phers categorized lesions of greater than or equal to 50% diameter ste nosis (n = 4,977) as clinically significant (86.4%) or nonsignificant (13.6%), and as favorable or nonfavorable for PTCA or CABG. More lesio ns were considered favorable for revascularizatian by CABG than by PTC A (91.5% vs 78.4%; p < 0.001), particularly in the subgroup of 99% to 100% lesions (77.6% for CABG vs 21.9% for PTCA; p < 0.001). Lesion fea tures, characterized by the BARI core laboratory, were correlated with clinical site angiographers' assessment of clinical importance and su itability for PTCA or CABG. By multivariate analysis, positive predict ors of clinical importance for 50% to 95% stenoses were greater stenos is severity, more jeopardized myocardium, larger reference diameter, a nd proximal vessel location. For 99% to 100% occlusions, predictors we re shorter duration of occlusion and more jeopardized myocardium. PTCA suitability for 50% to 95% stenoses wets inversely related to lesion length, ostial location, location on a bend, difficult access, and age , and was directly associated with greater Thrombolysis in Myocardial Infarction (TIMI) trial flow rate and more jeopardized myocardium. Pre dictors of PTCA suitability for 99% to 100% lesions were a lower Ameri can College of Cardiology/American Heart Association class and higher TIMI grade. Predictors for 50% to 95% stenoses were more jeopardized m yocardium, larger reference diameter, and more proximal vessel locatio n, and for 99% to 100% occlusions, more jeopardized myocardium and sho rter duration of occlusion. Suitability for PTCA depended on lesion po tency (<99%) and multiple morphologic characteristics that contrasted with the few angiographic features that adversely affect CABG suitabil ity.