COMPARISON OF CORONARY-BYPASS SURGERY WITH ANGIOPLASTY IN PATIENTS WITH MULTIVESSEL DISEASE

Background Coronary-artery bypass grafting (CABG) and percutaneous tra nsluminal coronary angioplasty (PTCA) are alternative methods of revas cularization in patients with coronary artery disease. We tested the h ypothesis that in selected patients with multivessel disease suitable for treatment with either procedure, an initial strategy of PTCA does not result in a poorer five-year clinical outcome than CABG. Methods P atients with multivessel disease were randomly assigned to an initial treatment strategy of CABG (n=914) or PTCA (n=915) and were followed f or an average of 5.4 years. Analysis of outcome events was performed a ccording to the intention to treat. Results The respective in-hospital event rates for CABG and PTCA were 1.3 percent and 1.1 percent for mo rtality, 4.6 percent and 2.1 percent for Q-wave myocardial infarction (P<0.01), and 0.8 percent and 0.2 percent for stroke. The five-year su rvival rate was 89.3 percent for those assigned to CABG and 86.3 perce nt for those assigned to PTCA (P=0.19; 95 percent confidence interval of the difference in survival, -0.2 percent to 6.0 percent). The respe ctive five-year survival rates free from Q-wave myocardial infarction were 80.4 percent and 78.7 percent. By five years after study entry, 8 percent of the patients assigned to CABG had undergone additional rev ascularization procedures, as compared with 54 percent of those as sig ned to PTCA; 69 percent of those assigned to PTCA did not subsequently undergo CABG. Among diabetic patients who were being treated with ins ulin or oral hypoglycemic agents at base line, a subgroup not specifie d by the protocol, five-year survival was 80.6 percent for the CABG gr oup as compared with 65.5 percent for the PTCA group (P=0.003). Conclu sions As compared with CABG, an initial strategy of PTCA did not signi ficantly compromise five-year survival in patients with multivessel di sease, although subsequent revascularization was required more often w ith this strategy. For treated diabetics, five-year survival was signi ficantly better after CABG than after PTCA. (C) 1996, Massachusetts Me dical Society.