5-YEAR CLINICAL AND FUNCTIONAL OUTCOME COMPARING BYPASS-SURGERY AND ANGIOPLASTY IN PATIENTS WITH MULTIVESSEL CORONARY-DISEASE - A MULTICENTER RANDOMIZED TRIAL

Objective.-To compare clinical and functional status in patients who h ad similar 5-year survival after coronary artery bypass grafting (CABG ) and percutaneous transluminal coronary angioplasty (PTCA). Design.-R andomized trial of 1829 patients followed for an average 5.4 years. Pa rticipants.-Patients with multivessel coronary artery disease suitable for both CABG and PTCA and not previously revascularized. Interventio n.-Coronary artery bypass grafting or PTCA within 2 weeks after random ization. Outcome Measures.-Symptoms, exercise test results, medication use, and quality-of-life measures collected at 4 to 14 weeks, and at 1, 3, and 5 years after randomization. Analysis.-Intention to treat. R esults.-Differences in angina-free rates between patients assigned to PTCA and CABG decreased from 73% vs 95% at 4 to 14 weeks (P<.001) to 7 9% vs 85% at 5 years (P=.007). Similar patterns were observed for exer cise-induced angina and ischemia, except 5-year differences were not s ignificant. At follow-up of 1 year and later, quality of life, return to work, modification of smoking and exercise behaviors, and cholester ol levels were similar for the 2 treatments. Compared with patients as signed to CABG, use of anti-ischemic medication was higher in patients assigned to PTCA, while smaller differences were observed for other m edications. Among patients angina-free at 5 years, 52% of patients who had PTCA required revascularization after the initial procedure vs 6% of patients who had CABG. Conclusions.-The narrowing of treatment dif ferences in angina and exercise-induced ischemia rates can be attribut ed to a return of symptoms among patients assigned to CABG and increme ntal surgical procedures among patients assigned to PTCA. Patients ass igned to PTCA apparently were able to tolerate higher rates of residua l ischemia as evidenced by comparable quality of life and 5-year survi val.